PATIENT REP IV-REFUND

Overview

Accurately review and process all third party payor, collection agency, patient, and other payments. Review the accuracy of credit balance status and prepare the necessary documentation for refunds.

Responsibilities

PRINCIPAL DUTIES AND RESPONSIBILITIES(*Essential Functions)

Reviews work-queues for credit balances and determines resolution.

Reports Medicare Credits to the Medicare Collection Associate for claim adjusting and files Quarterly report to Medicare.

Research and prepare refund requests and adjustments to correct account balances.

Process refunds/adjustments to the appropriate unit or clinic and reoccurring accounts.

Codes accounts for unit billing payments, deductibles, coinsurance, co-pay, etc., for contract management system.

Responds to customer phone calls regarding requests for refunds.

Identifies and notifies Finance of unclaimed property to be turned over to the State.

Reviews, logs and reports on Medicaid Audits for possible billing to other payers.

Qualifications

JOB SPECIFICATIONS(Minimum Requirements)

KNOWLEDGE, SKILLS, AND ABILITIES
• Accuracy rate of 95% must be maintained.
• Productivity requirement of 8.67 accounts per hour must be met.
• Insurance Audit Requests must be logged, investigated, and findings reported within timeline requirement.
• New credit balances reviewed each day to ensure accurate cash posting to account.
• Trends of credits need to be reported in order to find a resolution.
• Agencies must be contacted to ensure all debts are settled before refunding.
• Knowledge of UB-92 and 1500 billing preferred.
• Must have working knowledge of insurance claim filing, collections, and established refund processing procedures.
• Ability to prioritize job functions, work independently and exercise good judgment.
• Must possess good written and verbal communication skills.
• Must possess good organizational/analytical skills and mathematical aptitude.
• Proficient use of calculator and minimum typing (55 wpm).
• Basic personal computer skills.

EDUCATION

• High School Diploma/GED Equivalent General Studies Required
• Associates Business Preferred
• 6 Healthcare/Medical - Business Office Required

STANDARDS OF BEHAVIOR Meets the Standards of Behavior as outlined in Personnel Policy and Procedure #1, Employee Relations Code. CONFIDENTIALITY/HIPAA/CORPORATE COMPLIANCE Demonstrates knowledge of procedures for protecting and maintaining security, confidentiality and integrity of employee, patient, family, organizational and other medical information. Understands and supports the commitment of Methodist Hospitals in adhering to federal, state and local laws, rules and regulations governing ethical business practices for healthcare providers. DISCLAIMER - The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. The statements are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required.