Job Title: Refund Analyst
Department: MedSrv Cash Management
Reports to: Department Director
FLSA Status: Non Exempt
Revised Date: April 28, 2022
SUMMARY
Reviews all accounts with a credit balance by assigned. Issues refund to patient or insurance carrier; contacts insurance carrier to offset overpayment.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.
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Works Credit Balance Report by provider group/Work Queue (s) daily
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Attaches supporting EOBs and documentation to Refund letter and save in a designated folder on the T drive to be attached to refund check for mailing
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Notates each account explaining why the refund was issued and utilizes appropriate Kickcode when applicable
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Open case with CSC in Athena for any accounts that need corrections made due to posting errors and pend claims to allow for resolution
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Communicate posting errors in Epic to Directors for corrections
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Follow up on any unresolved case in Athena greater than 10 days old.
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Utilizes websites for up-to-date refund policies, overpayment forms, etc.
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Send Overpayment Letters to insurance companies with all EOBS to determine to if overpayments can be recouped from a future remit in lieu of sending a refund.
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Adjust Credit balance for all carriers except Government with appropriate adjustment code when OPL letter is sent
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Credits for Government carriers will be kicked with the appropriate code once OPL letters are sent.
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Work all correspondence within 7 days of receipt
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Maintains average productivity of 5 claims an hour/40 accounts worked per day.
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Must be able to meet established and agreed-upon goals within 90 days of continuous employment.
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Must have the ability to get along with others in a close office setting.
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Must have the ability to concentrate for extended periods of time.
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Must be willing to function and cooperate as a member of a team.
QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and/or EXPERIENCE
High school diploma or equivalent; 1-year related experience and/or training; or equivalent combination of education and experience required. Good computer and keyboarding skills are required. Must have knowledge of office software and medical billing software.
LANGUAGE SKILLS
Ability to read and interpret documents such as procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.
MATHEMATICAL SKILLS
Ability to calculate figures and amounts such as discounts, interest, and percentages.
REASONING ABILITY
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
PHYSICAL DEMANDS
The physical demands described here 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 individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit and use hands to finger, handle, or feel. The employee frequently is required to talk or hear. The employee is occasionally required to stand, walk, and reach with hands and arms. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, and the ability to adjust focus.
WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.