Refund Specialist - #19529455
Universal Health Services
The Refund Specialist is responsible for the accurate and timely resolution of the Practice Management System (PMS) self-pay and insurance credits. Thoroughly researches credit balances to determine if an overpayment occurred and initiates the refund process accordingly outlining the reason for the refund and including explanation of benefits (EOBs), if needed. Handles payer refund requests including validating the refund following review of the account history and submission of a refund request to Accounts Payable. Meets or exceeds established performance targets (productivity and quality) established by their supervisor. Partners with the Reimbursement Specialists, as needed, to research accounts and validate self-pay and insurance refunds. Maintains a working knowledge of CPT-4 and ICD-10 coding principles, government, managed care and commercial payers, payment posting, ERA processing, claim adjustment reason codes, contractual adjustment, copays, coinsurance and deductibles. Demonstrates the ability to be an effective team player. Upholds "best practices" in day to day processes and work flow standardization to drive maximum efficiencies across the team.
Education: High School Graduate/GED required. Technical School/2 Years College/Associates Degree preferred.
Work experience: Experience (3-5 years minimum) working in a healthcare (professional) billing, health insurance or equivalent operations work environment.
Knowledge: Healthcare (professional) billing, knowledge of CPT/ICD-10 coding, claim submission requirements, payment posting and remittance processing. Understanding of the revenue cycle and how the various components work together preferred.
Skills: Excellent organization skills, attention to detail, research and problem solving ability. Results oriented with a proven track record of accomplishing tasks within a high-performing team environment. Service-oriented/customer-centric. Strong computer literacy skills including proficiency in Microsoft Office.