Refund Specialist: Insurance Claims

2 weeks ago

Atlanta, Georgia, United States Rose International Full time
Job Summary

We are seeking a highly skilled Refund Specialist to join our Credits Team in our Revenue Operations Department. As a Refund Specialist, you will play a critical role in analyzing EOBs and/or payor correspondence to reconcile system credit balances or potential overpayments, research and resolve problem accounts, and request adjustments.

Key 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
  • Utilize strong organizational skills to effectively manage large amounts of detailed information
  • Collaborate and maintain positive working relationships with peers, leaders, clinical personnel, and payer representatives to resolve credit balances
  • Contribute to implementation of process improvement initiatives aimed at improving credit department efficiency
  • Ensure 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 Client policies
Requirements
  • Strong Refund experience required, 4+ years hands on experience
  • 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 Offer

Rose International is an Equal Opportunity Employer. We offer a hybrid and remote work environment, all necessary workstation equipment, and a competitive benefits package. For information and details on employment benefits offered with this position, please visit our website.

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