Credit Balance and Refund Specialist

2 days ago

Doral, Florida, United States Advanced Diabetes Supply Full time
About the Position

Hours: 8:00 AM to 4:30 PM ET, Monday to Friday (HYBRID)

Location: Doral, FL

Job Summary: We are seeking a highly skilled Credit Balance and Refund Specialist to join our team at Advanced Diabetes Supply. As a key member of our Revenue Cycle team, you will be responsible for resolving credit balance accounts for third-party payers and patients, ensuring compliance with industry standards.

Key Responsibilities
  • Timely and accurately resolve credit balance accounts, refund or takeback requests.
  • Utilize knowledge of insurance processes, coordination of benefits, claims processing, state and federal statutes regarding overpayment regulations.
  • Review and analyze accounts and/or reports from insurance companies and patients to facilitate the resolution of credit balance accounts.
  • Proactively identify, research, and resolve unusual, complex, or escalated issues, as necessary.
  • Document all activities and findings in accordance with established policies and procedures.
  • Meet quality assurance and productivity standards through identification, reconciliation of credit balance accounts and review of credit balance reports for potential overpayments.
Requirements
  • High School diploma or equivalent
  • 3-5 years experience in medical revenue cycle with previous posting and remittance experience
  • Knowledge of general concepts and practices that relate to the healthcare field, and specific policies, standards, procedures, and practices that pertain to the assigned function.
  • Knowledge of the insurance follow-up process for government and non-government payers, including the CMS 60-day overpayment rule.
  • Knowledge of insurance company contract rates
  • General computer skills, typing skills, and a working knowledge of Medicare, Commercial Payer, and HIPAA Compliance
  • Basic understanding of accounts receivables in a healthcare setting
  • Basic math and business calculations
  • Working knowledge of computer/data entry with the ability to learn new systems
  • Basic level of MS Office proficiency
Expected Competencies
  • Friendly, professional, and effective communications skills; able to calmly present solutions in challenging situations.
  • Proactive identification of challenges, and solution-oriented approach to problem solving.
  • Service-orientation and aptitude to resolve insurance and/or patient matters.
  • Effective analytical skills: able to use inductive and deductive reasoning to anticipate outcomes.
  • Self-directed accountability and reliability
  • Effective communication, and interpersonal skills, with the ability to influence and collaborate effectively with cross-functional teams.
  • Able to manage and prioritize multiple tasks/projects, work autonomously, and meet deadlines.
  • Able to work well in a team environment that promotes inclusiveness and communication among team members.
  • Communication using both verbal and written English proficiency.
  • Cultural competence
Physical Demands

The physical demands described below are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable employees with disabilities to perform the essential functions. While performing the responsibilities of the job, the employee is required to remain in a stationary position most of the time (stand or sit). While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle, or feel; and talk or hear. The employee is frequently required to stand, walk, and reach with hands and arms. The employee is occasionally required to stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by this job include close vision and ability to adjust focus.

Other Requirements
  • Candidates must successfully pass a background check.
  • Candidates must be able to provide proof of eligibility to work in the United States without sponsorship.

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