Payment Posting Specialist (Refund)

Role:

The Refunds Specialist is responsible for overseeing all refund requests and credit balances to ensure accounts are accurately managed for posting correction or refund procedures follow payor guidelines and/or federal regulations when determined valid.

Responsibilities:

• Review all encounters in detail when refund has been requested and determine proper protocols to process refund
• Identify posting errors causing credit balance, correct and close out necessary tasks as necessary
• Create, modify, and maintain policies and procedures based on state, local and payor regulations.
• Develop training material for staff and RCM leadership based on researched guidelines.
• Follow all compliance policies and advise RCM leadership of changes in policies.
• Maintain an appropriate turnaround time to process refunds when identified to be an accurate refund request.
• Contest refunds when appeal rights are supported by medical necessity, payor policies or patient eligibility.
• Ensure that staff working credit balances, refund requests or unpostable accounts is trained and monitored for production and quality standards.
• Report any issues/trends related to claims processing by payors where a large volume of claims is deemed payable and the refund is not warranted.
• Understand and follow all payor guidelines for payment policy and refund processes required.
• Ensure approval matrix is adhered to for all refunds according to refund amount.

Required Skills:

• 3-5 years of Refunds Experience
• 3+ Years of Revenue Cycle Management Experience
• Proficient in Payment Posting and Refunds process
• Ability to collaborate with other leaders and subject matter experts
• Excellent Communication Skills
• Critical Thinking Skills

Education and Experience:

Bachelors Degree or at least 3 years related experience required.