Patient Accounting Representative I - Reimbursement-Refunds

Patient Accounting Representative I - Reimbursement-Refunds

Will be responsible for working insurance and patient credit balances and refund requests. This individual plays an active role in the Revenue Cycle by accurately applying contracts, requesting adjustments and refunding overpayments while tracking and trending for process improvement. Keeps management apprised to any issues related to credit balances and posting.

Job Qualifications

• Associate's Degree in Accounting, Business Administration, Finance or at least two (2) years in a related field which can be substituted for a degree.
• Preferred minimum of two (2) years of healthcare experience in the area of reimbursement methodologies including managed care contracts, Medicaid and Medicare.
• Preferred knowledge of electronic remittance posting, interpretation of explanation of benefits, cash applications and batch posting processes.
• Preferred knowledge in third party billing and collections in a hospital setting.
• Excellent analytical, communication and organizational skills with strong attention to detail.
• Self-starter with the ability to work with minimal supervision.
• Proficient PC skills including Microsoft Outlook, Word and Excel.
• Must be able to function and meet deadlines under stressful conditions and prioritize work flow.

Job Duties and Responsibilities

• Processes third party and patient refunds in adherence with company policy.
• Researches credit balance accounts for possible refund or retraction.
• Reviews incoming refund requests, via mail or fax from insurance or audit companies, for validity and responds appropriately.
• Sends any necessary adjustments, posting corrections or payment transfers to the Payment Poster Specialist.
• Coordinates refunds/retractions with third party vendors working on behalf of Halifax Health in accordance with company policy.
• Compose letters or faxes disputing refunds to insurance or audit companies.
• Call insurance companies to obtain additional information concerning the credit balance.
• Complete audits from insurance companies or internal compliance in a timely manner.
• Submits refund posting report to the Accounting department weekly.
• Responds to system tasks in a timely manner.
• Contributes to effective working relationships by demonstrating a positive and helpful attitude with co-workers.
• Maintains privacy strictly adhering to HIPAA guidelines.
• Performs other duties as assigned