Accounts Receivable Representative Ii (Hybrid)

Job Summary: 

This role will be hybrid - 2 days onsite and 3 days working from home.
Under the supervision of the Manager, Revenue Cycle Management, the Credit and Refund Specialist ensures that credit balances are resolved within payer turnaround requirements. Audits credit balance accounts and validates refund or recoupments have been submitted and approved in thorough and timely manner; if applied payments should be refunded. Creates and publishes credit balance reporting regarding audit findings and reports compliance discrepancies.
Responsibilities (80%)
• Reviews credit balance accounts; verifies refund/recoupment is appropriate and submitted within the established payer agreements.
• Posts adjustments related to errors identified through daily audit of credit balance accounts.
• Assigns tasks to Reimbursement Specialist to communicate missed or additional steps needed
• Reviews and resolves credit balances or over-payments within established payer turnaround times.
• Monitors daily posting of payments to capture new overpayments and schedules appropriate follow-up to ensure credit is worked timely.
• Collaborates with the Billing Supervisor and Refund & Reconciliation Analyst to ensure manual refunds are processed within established turnaround times.
• Generates daily, weekly, monthly, quarterly and annual reports tracking total credit balances pending and status of recoupments/refunds.
• Build strong, positive and professional relationships with Billing, Cash Application and Reimbursement Specialists
• Communicate and collaborate with the internal departments.
• Maintains strict confidentiality of patient personal information.
• Maintains HIPPA compliance.
• Understands business implications of decisions.
• Performs other duties as requested by supervisor or manager.
Processes, Procedures and Systems (10%)
 Reviews, understands and follows department policies, Standard Operating Procedures and job aides.
 Notifies Supervisor and Manager of any defects or enhancement opportunities for SOP’s and job aides.
 Assists with annual review of SOP’s and job aides.
Mentoring and Special Projects (10%)
 Assists peers in answering processing questions and assists in training new hires
 Notifies Manager of any defects or enhancement opportunities for SOP’s and job aides
 Assists with annual review of SOP’s and job aides
 Assumes responsibility for credit/recoupment/refund related special tasks or assignments
 Serves as subject matter expert in the absence of the Manager
 Collaborates with external and internal team members and customers to create a positive experience for customers and minimizes days sales outstanding (DSO) and denials and maximizes cash collections
Qualifications
• Bachelor’s degree or equivalent work experience or combination of secondary education and work experience in a healthcare related setting
• Four years of direct work experience related to medical claims billing/collection or two years of direct refund processing experience
• Two or more years of direct medical claims adjustment approval experience
• Proven excellent verbal and written communication skills
• Strong computer skills, including word processing and spreadsheet software

Benefits: Paid Sick Leave, Medical/Dental (optional), 401 (k) Retirement Plan (optional), Employer Paid Life Insurance, Employer Paid Short Term Disability, Optional Life Insurance.

ELYON International, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.