Refund Specialist: Insurance Claims

3 weeks ago

Pasco, United States TalentBurst Full time
Title - Refund Specialist: Insurance Claims
Location - Federal Way, WA
Duration - 7+ Months of Contract
Shift - Monday- Friday 8-hour shift

Job Description:
Excited to grow your career?
Our client is currently looking for a Refund Specialist for our Credits Team in our Revenue Operations Department. Individuals who excel in this role are highly ambitious, results driven, and willing to "think outside the box. " This position requires a high level of attention to detail and the ability to work well as part of a fast-paced team. The ideal candidate has a high level of multitasking abilities, strong mathematical and analytical skills, and is driven by resolving open balances with the goal of preventing future rework. In this position, you will analyze EOBs and/ or payor correspondence to reconcile system credit balances or potential overpayments, research and resolve problem accounts, and request adjustments. You will effectively identify trends and analyze root causes to drive work efficiently within the team. Hybrid and remote positions available. All necessary equipment is provided.

ESSENTIAL DUTIES AND RESPONSIBILITIES:
• Autonomously research, initiate follow-up and resolve all health care insurance claim accounts with existing credit balances (claim(s) paid more than expected by payer); actions included but not limited to initiating refund packets, retractions, and/or adjustments to claims
• Navigate through various payer systems and multiple internal systems to ensure timely and accurate resolution of claims
• Use critical thinking, root cause analysis, and problem-solving skills to resolve issues on outstanding claim balances
• Uses strong organizational skills to effectively manage large amounts of detailed information
• Utilizes excellent written and oral communication skills to collaborate and maintain positive working relationships with peers, leaders, clinical personnel, and payer representatives to resolve credit balances.
• Contributes to implementation of process improvement initiatives aimed at improving credit department
• Ensures compliance by using established internal control procedures by examining records, reports, operating practices, and documentation
• Stay current on communications relating to healthcare reimbursement and regulatory changes
• Maintain confidentiality of all company and patient information in accordance with HIPAA regulations and DaVita policy
• Understand and adhere to all policies, laws and regulations applicable to this role
• Consistent, regular, punctual attendance as scheduled is an essential responsibility of this position
• Participate in group settings and teamwork environment

Qualifications:
• High School Diploma or equivalent required
• Healthcare and medical claim overpayment remediation and refunding experience is required
• 2-4+ years' experience with accounting, transactions, or medical billing/accounting systems required
• Knowledge or experience working with a variety of health care insurance payers is preferred
• Intermediate computer proficiency in Microsoft Office including Excel and Outlook- required
What We'll Provide:
• All necessary workstation equipment

Work Environment: Hybrid or Remote. Role requires a stationary, designated, and HIPPA Compliant workspace. Traveling with equipment is not permitted. Sonar Refund Specialist

#TB_HL

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