Refund & Quality Assurance Specialist

Title: Refund and Quality Assurance Specialist
Location: Federal Way, WA 98001
Contract: 6 months
Note:   These candidates with focus on quality/audits. Looking for candidates that specifically have refunding and overpayment remediation experience and/or Quality Assurance/Auditing experience listed on their resume in order to identify top talent for this initiative.
ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Research, initiate follow-up and resolve all health care insurance claim accounts with existing credit balances (claim(s) paid more than expected by payer); actions included but not limited to initiating refunds, retractions, and/or adjustments to claims
• Navigate through various payer systems and multiple internal systems to ensure timely and accurate resolution of claims
• Use critical and analytical problem-solving skills to resolve issues
• Uses strong organizational skills to effectively manage large amounts of detailed information
• Utilizes excellent written and oral communication skills to collaborate and maintain positive working relationships with peers, leaders, clinical personnel, and payer representatives to resolve credit balances.
• Contributes to implementation of process improvement initiatives aimed at improving credit department
• Supports monthly reporting of outstanding credit balances
• Validates quality processes by establishing process specifications and quality attributes, measuring production, documenting evidence, determining operational and performance qualification, and writing and updating Quality Assurance procedures.
• Prepares quality documentation and reports by collecting, analyzing and summarizing information and trends including failed processes, stability studies, recalls, corrective actions, and re-validations
• Ensures compliance with established internal control procedures by examining records, reports, operating practices, and documentation
• Stay current on communications relating to healthcare reimbursement and regulatory changes
• Maintain confidentiality of all company and patient information in accordance with HIPAA regulations and client policies
• Understand and adhere to all policies, laws and regulations applicable to this role; Appraises adequacy of internal control systems by completing audit questionnaires
• Consistent, regular, punctual attendance as scheduled is an essential responsibility of this position.

• 3-5+ years' experience with accounting, transactions or medical accounting systems a plus
  Health care and medical overpayment remediation and refunding or auditing experience is required
• Knowledge or experience working with a variety of health care insurance payers is preferred
• Intermediate computer proficiency in Microsoft Office including Excel and Outlook- required