Recoupment Representative, Client Financial Services

Job Description:

Job Summary:

The Recoupment Representative, Client Financial Services reviews and processes insurance overpayment requests, insurance credit balances, compliance audit repayments, and client credit balances. Incumbent collaborates and works with team members throughout the system to recover funds. Team members adhere to operational guidelines, maintain a professional code of ethics and comply with HIPAA guidelines and regulations.

Essential Job Functions:

• Analyze accounts receivable balances to identify and address insurance credit balances requiring resolution or repayment.

• Assess client payment credit balances on accounts and take necessary actions for resolution or repayment.

• Assist Compliance in repayment of services identified within an internal audit review for federally funded payers.

• Initiate and release guarantor holds in the electronic health system for client charts where an internal audit is being conducted.

• Reviews and validates insurance overpayment letters for federal and non-federal payers.

• Dispute requests for overpayment as necessary.

• Respond promptly to phone calls or emails regarding credit balance resolution or refunds.

• Process check refund requests with proper documentation and complete refund within the system.

• Review and follow-up on returned/undeliverable client refund checks.

• Initiate and monitor voided claims, following through to recoupment.

• Document workflows.

• Performs other duties as needed.

Knowledge, Skills, and Abilities:

• Ability to read and interpret explanation of (EOB) and remittance advices (RA).

• Familiarity with CPT and ICD-10 coding.

• Processes an understanding of how to use basic Microsoft Excel formulas as this will be used on a daily basis.

• Ability to work in multiple electronic health systems.

• Utilize insurance websites, provider portals, send secure messages and make phone calls to insurance companies.

• Must demonstrate knowledge of insurance billing/collection practices.

• Strong data analysis skills, especially with system reports.

• Proactive problem-solving and ability to implement solutions independently.

• Proficient in reading and following policies and procedures.

• Effective time management and multitasking under deadlines.

• Excellent verbal and written communication skills.

• Comfortable and proficient with computer systems, including Microsoft Word and Excel.

• Ability to securely handle confidential information.

• Experience documenting processes.

• Detail-oriented with strong prioritization skills.

• Accurate data entry and 10-key proficiency.

• Ability to work independently and collaboratively in a positive manner.

• Familiarity with insurance portals and medical terminology preferred.

Experience and Education Qualifications:

• High school diploma or General Educational Diploma (GED) is required.

• At least three years of experience in a healthcare setting, with a focus on billing, collections, payment processing, or denial management required.

• Preferably certified in Billing and/or Coding.

• Experience with Missouri Certified Community Behavioral Health Organization (CCBHO) and managed care organization (MCO) billing is advantageous.

Supervisory Requirements:

• None

Employment Requirements:

• Successful completion of background check including criminal record, driving record, abuse/neglect and fingerprint check.

• Completion of New Hire Orientation at the beginning of employment.

• All training requirements including Relias at the beginning of employment and annually thereafter.

• Current driver’s license, acceptable driving record and current auto insurance.

Physical Requirements:

ADA Consideration - Sedentary work: Exerting up to 10 pounds of force occasionally (exists up the 1/3 of the time) and/or a negligible amount of force frequently (exists 1/3 to 2/3 of the time) to lift, carry, push, or pull, or otherwise move objects, including the human body. Repetitive movements of hands, fingers, and arms for typing and/or writing during work shift.

Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.

Position Perks & Benefits:

Paid time off: full-time employees receive an attractive time off package to balance your work and personal life

Employee benefits package: full-time employees receive health, dental, vision, retirement, life, & more

Top-notch training: initial, ongoing, comprehensive, and supportive

Career mobility: advancement opportunities/promoting from within

Welcoming, warm, supportive: a work culture & environment that promotes your well-being, values you as human being, and encourages your health and happiness.

Brightli is on a Mission:

A mission to improve client care, reduce the financial burden of community mental health centers by sharing resources, a mission to have a larger voice in advocacy to increase access to mental health and substance user care in our communities, and a mission to evolve the behavioral health industry to better meet the needs of our clients.

As a behavioral and community mental health provider, we prioritize fostering a culture of belonging and connection within our workforce. We encourage applications from individuals with varied backgrounds and experiences, as we believe that a rich tapestry of perspectives strengthens our mission. If you are passionate about empowering local communities and creating an environment where everyone feels valued and supported, we invite you to join our mission-driven organization dedicated to cultivating an authentic workplace.

We are an Equal Employment Opportunity Employer.

Burrell Behavioral Health is a Smoke and Tobacco Free Workplace.