Refund Proc Rep I

About the role

Facilitate the reduction of credit balances and refund requests within Advocate Health Hospital Billing and Professional Billing entities, ensuring appropriate contract reimbursement rates are applied. Focus on highly complex accounts as needed.

Responsibilities

• Review and research requests via multiple systems, electronic inboxes, mail, work queues, legacy system reports, vendor, audit, and compliance projects within the appropriate time frame.
• Conduct high-level analysis of other team members' transactions before releasing to payee, including escalated requests, using sound decision-making skills.
• Determine the payor responsible for overpayment, verify coordination of benefits, reimbursement calculations, and payment sources, and follow system processes and department procedures to resolve.
• Identify and report root causes of credit balances and payer refund trends; partner with internal and external counterparts.
• Document patient and guarantor account notes with all actions taken to resolve credit or refund requests.
• Demonstrate extensive knowledge of refund/adjustment processes and utilize systems/applications proficiently to resolve credit balances and process refunds.
• Drive improvement initiatives within daily work, collaborate with peers as a resource, and encourage engagement to positively impact department and system goals.
• Work with the Revenue Cycle Process Designer as needed to update or draft workflow updates.
• Oversee ad hoc high-level projects independently and related job activities as assigned to support department operations.
• Assist with patient accounting activities during high volume periods or impending deadlines.
• Consistently exceed quality assurance and productivity standards.

Requirements

• High School Graduate or equivalent.
• Typically requires 3 years of experience in a healthcare business setting.

Skills

• Strong organizational ability and communication skills (written and verbal).
• Expert ability to read, enter, and retrieve information from multiple patient accounting systems.
• Proficient understanding of Microsoft Office.
• Bookkeeping skills and a strong mathematics aptitude.
• Strong ability to work independently, under pressure in a fast-paced environment.
• Strong attention to detail and maintains a high degree of accuracy.
• Strong knowledge of Managed Care payer contract terms and Medicare/Medicaid payer guidelines.
• Ethical conduct.
• Regular and reliable attendance.

Physical Requirements and Working Conditions

• Lifting 10 pounds or more for mailing.
• Sitting for extended periods of time.