Refund and Adjustment Specialist

1 week ago


Green Bay, Wisconsin, United States BayCare Clinic Full time
Job Title: Refund and Adjustment Specialist

BayCare Clinic is seeking a highly skilled Refund and Adjustment Specialist to join our team in Green Bay, WI. As a key member of our revenue cycle team, you will be responsible for ensuring accurate and timely reimbursement for our patients.

Key Responsibilities:
  • Review and process refund requests from insurance companies, including recoupment of payment.
  • Research and resolve payment discrepancies, ensuring compliance with BayCare contracts and business guidelines.
  • Work closely with Accounts Payable to reconcile refunds and ensure accurate preparation of claims.
  • Responsible for reviewing and approving adjustments received from Patient Accounts and clinic practice sites.
  • Perform detailed audits to identify payment trends or missed revenue opportunities.
Requirements:
  • At least 2-3 years' experience in patient account billing, with prior account collection knowledge and expertise in medical terminology, CPT, ICD-9, HCPCS, RVU, and commercial billing.
  • EPIC knowledge preferred, but not necessary.
  • Knowledge of insurance principles and insurance contracts.
  • Collection and negotiation skills.
  • General accounting principles, with the ability to calculate figures such as discounts and percentages.
  • Proficient with Microsoft Word, Excel, and the internet.
  • Research and resolve payment discrepancies.
  • Requires written and verbal skills with the ability to communicate complex concepts.
  • Problem-solving skills, with the ability to systematically analyze problems, draw relevant conclusions, and devise appropriate courses of action.
  • Able to research and resolve payment discrepancies.
  • Self-starter with the ability to work independently.
  • Strong organizational skills with the ability to prioritize and complete projects.
About BayCare Clinic:

BayCare Clinic is a successful, dynamic group comprised of 19 specialties. We are a physician-owned entity with joint ownership in Aurora BayCare Medical Center, a 167-bed hospital located in Green Bay, WI. We offer a comprehensive benefits package, including health, dental, disability, and life insurance, as well as flexible spending options and a 401k retirement plan with a company match.

We believe in the power of a positive, collaborative culture, and we strive to provide a supportive and energizing work environment. Every member of our team has a voice and is trusted to have ownership over their work. We provide regular opportunities for professional development, seek out feedback and ideas, and invite participation on a variety of projects.



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