Physician Billing Refund Specialist

JOB SUMMARY:
Ensures accounts with patient and insurance credit balances, including business guarantor accounts or "unapplied cash accounts," are reviewed and refunds processed on a timely and accurate basis. Responsible for researching various payer contracts to determine appropriate reimbursement amounts, providing adequate documentation, and processing refunds, transferring balances, and completing corresponding contractual adjustments.
CORPORATE PHILOSOPHY:
It is the obligation of each employee of Edward - Elmhurst Health to abide by and promote the mission and values of the System to ensure that excellent services are delivered with compassion.
PRINCIPAL DUTIES AND RESPONSIBILITIES: (The following duties and responsibilities are all essential job functions, as defined by the ADA, except those that begin with the word "May.")
+ Monitors and reviews accounts with credit balances daily, identifying and verifying the refund owed and the correct payer owed
+ Investigates and resolves credit balances by transferring credits from one account to another, posting refunds, and calculating and entering required third-party adjustments
+ Submits refund requests to the Supervisor, Physician Billing and when required Manager, Physician Billing, including all the proper supporting documents as well as copies of all payments rendered on the account
+ Appropriately responds to requests from patients and third-party payers for refunds
+ Interpret contract terms from third-party payers to accurately identify appropriate payment
+ Monitor and review the transfer of balances to outside agencies ensuring proper authorization signatures
+ Research and complete payer takeback requests to resolve outstanding credit balances
+ Review and monitor the integrity of account follow-up reports from outside agencies, ensuring payment demands are proper and accurate
+ Respond to requests for documentation, bill reprints, and other correspondence from patients and outside collection agencies
+ Contact patients and insurance companies as necessary to gather information needed to determine the appropriate course of action to resolve a credit balance
+ Meets productivity standards, targets, error ratios and reporting requirements as assigned by the department Manager or Supervisor
+ Participates in department meetings and training seminars as assigned by the department Manager or Supervisor
+ Utilizes assigned menus and pathways in the hospital mainframe system. Reports software application problems to the appropriate Supervisor.
+ Utilizes assigned menus and pathways in foreign software applications. Reports software application problems to the appropriate Supervisor
+ Utilizes assigned computer hardware. Reports hardware problems to the appropriate Supervisor
+ When appropriate, works with outside vendors to resolve issues and problems on foreign software systems and applications
+ Participates in the testing for assigned software applications, including verification of field integrity
Assists with special projects as assigned