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Credit Balance and Refund Specialist

2 months ago

Miami, United States North Coast Medical Supply LLC Full time
About Our Company

At Advanced Diabetes Supply, we're dedicated to creating a knowledgeable, reliable, and superior diabetes supply company. Our approach, coupled with a commitment to service and innovation, has propelled us to a national leader in the industry. We strive to maintain a casual, fun environment while working hard every day to provide a positive work culture and respectful atmosphere.

About The Position

Schedule: 8:00 AM - 4:30 PM ET, Monday - Friday (HYBRID)

Location: Doral, FL

Job Summary

The RCM Credit Balance and Refund Specialist resolves credit balance accounts for third-party payers and patients by reviewing claims, payments, and denials while ensuring compliance with industry standards. This role requires a strong understanding of payor requirements, contracts, and claims processing to maintain accuracy and exceed customer expectations.

Key Responsibilities
  • Responsible for timely and accurate resolution of credit balance accounts, refund or takeback requests.
  • Completes knowledge of insurance processes, coordination of benefits, claims processing, state and federal Statutes regarding overpayment regulations.
  • Reviews and analyzes accounts and/or reports from insurance companies and patients to facilitate the resolution of credit balance accounts.
  • Utilizes available resources to review payment discrepancies and identify trends/reasons for future discussion.
  • Proactively identifies, researches and resolves unusual, complex or escalated issues, as necessary. Escalates ongoing issues or concerns to management.
  • Documents all activities and findings in accordance with established policies and procedures; ensures the integrity of all account documentation; maintains confidentiality of medical records.
  • Meets quality assurance and productivity standards through identification, reconciliation of credit balance accounts and review of credit balance reports for potential overpayments in accordance with organizational policies and procedures.
  • Maintains current knowledge of internal, industry, and government regulations as applicable to assigned function.
  • Works with payers, Payer Contracting, RCM leadership, Finance, and any other team members in resolving credit balance issues.
  • Completes due diligence on all refund requests to ensure that request is valid and accurate in terms of payer contractual and proper documentation.
  • Processes adjustments for accounts with credit balances that have occurred due to posting corrections, write-off's, rate changes.
  • Prepares refund packages with all supporting documentation and obtain required signatures for approval.
  • Serves as a dedicated resource person to answer questions pertaining to credit balance.
  • Recommends and identify overpayment trends for future billing and collection improvement.
  • Adapts quickly to frequent process changes and improvements.
  • Is reliable, engaged, and provides feedback as to improve processes and policies.
  • Attends all department, team, and company meetings as required.
  • Meets company quality standards.
  • Embraces and exemplifies ADS core values:
  • We put our people first.
  • We serve our members with passion.
  • We take ownership.
  • We pursue excellence.
  • We never stop growing.
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 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.
Pay Range and Compensation Package

Pay ranges may vary depending on location. Actual compensation depends on education, experience, and relevant skills.

Benefits for full-time employees include:

  • Health, Dental & Vision options
  • FSA and HSA plan with Employer Contribution
  • Employer paid EAP
  • 401k with 4% Company Match
  • Discretionary Profit-Sharing Plan
  • Paid Time Off (PTO) Including 7 Paid Holidays and a Birthday Holiday
  • On-Site Gym
  • In-house Training Programs
  • A fun culture in a fast-growing organization
Equal Opportunity Statement

Advanced Diabetes Supply provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type based on race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.