PRI-Refunds Representative

Job Description

Position Purpose:

To process medical billing claims, collect patient or provider payments, resolve questions and problems with a customer’s accounts, process patient refunds, appeals to include re-determinations and re-submissions of billing to patient payers for payment on medical supply orders.

To accurately identify and complete offset/recoupment and/or refund requests to various payers, as well as, patients, resolve questions and problems with patient refunds, and submit appeals and disputes for involuntary offsets/recoupments/chargebacks.

Primary Duties and Responsibilities

• Receive payment denials and to investigate the reason and rectify the situation with the payer or patient
• Review all returned supplies to determine even exchange versus partial and full product returns
• Review all internal and external refund requests to accurately identify if an overpayment was made and/or if a refund is due to the payer and/or patient
• Complete the necessary forms and/paperwork to request a voluntary offset/recoupment/refund request when applicable within the amount days dictated by the payer and/or contractual obligations
• Request and/or complete claim adjustments and/or voids to ensure that claims for supplies that have been returned or claims billed in error have been voided/adjusted in the payer’s system to reflect accurate information when applicable within the amount days dictated by the payer and/or contractual obligations
• Receive inbound and place outbound calls from and to customers, Medicare, Medicaid and Commercial insurance providers regarding patient accounts
• Provide written correspondence to audit requests to include investigation and obtaining of appropriate documentation to be attached to response
• Document status of billing and payment process in patient account for future follow-up
• Keep current on payer requirements via research and coaching to ensure guidelines and procedures are being met for each payer
• Answer and follow up on calls from patients with billing questions
• Complete all end of month reports as requested, directed or assigned
• Complete all internal system service ticket requests as assigned
• Work miscellaneous projects and tasks on an as needed basis

Ancillary Duties and Responsibilities

• Maintain a positive work atmosphere that embodies Liberator’s philosophy- Professional excellence, teamwork and integrity.
• Maintains a production level between 20-40 accounts per day ensuring quality of work is above average.
• Production rates are at the discretion of management and are subject to change with our without prior notification.
• Maintains a better than average attendance score
• Performs other duties and tasks as assigned

Reporting Relationship Responsibilities

• No supervisory responsibilities

Minimum Requirements or Qualifications

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
• The requirements listed below are representative of the knowledge, skill, and/or ability required.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education/Experience:

• High School Diploma or general education degree (GED); two to four years prior medical supply billing experience and/or 1-3 years prior experience as an AR Billing Representative I exceeding performance levels and expectations for that role.

Skills

• Language: Ability to read, analyze, and interpret medical supply publications, technical procedures, and/or training tools. Ability to write internal and external business correspondence.
• Math: Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, and percentages. Ability to apply intermediate math skills.
• Reasoning: Ability to solve practical problems and deal with a variety of variables. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Advanced analytical reasoning to include ability to forecast exponentials within work flow processes and reason against outside factors.
• Computer: Knowledge of Microsoft Office Applications, Access or other database software.
• Telecommunications: Ability to utilize or knowledge of call center telecommunications software

Licensure or Certifications required

• No certifications required

Work Requirements

• Ability to work some evening shifts, weekends, and overtime as needed

Physical Demands

• While performing the duties of this job, the employee is frequently required to walk, sit; use hands to finger, handle, or feel and talk or hear.
• The employee is occasionally required to stand.
• The employee must occasionally lift and/or move up to 10 lbs.

Work Environment

• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• While performing the duties of position, the employee performs tasks in a temperature controlled office environment under normal office conditions.
• The noise level in the work environment is usually moderate.
• The work environment involves minimal exposure to hazards or physical risks, which require following basic safety precautions.