What are the responsibilities and job description for the Hospital Refund Specialist position at Dallas CSO - Hospital (01072)?
Role and Responsibilities:
The Hospital Refund Specialist has the responsibility of identifying and resolving credit balances on patient accounts to ensure refunds are issued in a timely manner. This position ensures the highest quality and safe delivery of customer service, maintain compliance with professionalism and regulatory processes. Interface with facility clients and internal corporate stakeholders.
- Manage daily work queues of credit balances for both onshore & offshore teams.
- Research, initiate follow-up and resolve all health care insurance claim accounts with existing credit balances.
- Complete thorough review of patients’ accounts with credit balances to validate the patient overpayment is accurate.
- Recommend an adjustment when applicable or recommend a refund of the overpayments to the insurance carrier or patient, providing the appropriate documentation.
- Apply knowledge related to insurance contracts, interpret explanation of benefits, understand regulations concerning coordination of benefits and other applicable guidelines.
- Process refunds accurately and in timely manner adhering to contract language where appropriate.
- Navigate through various payer systems and multiple internal systems to ensure timely and accurate resolution of claims.
- Use critical and analytical problem-solving skills to resolve issues
- Uses strong organizational skills to effectively manage large amounts of detailed information
- Utilizes excellent written and oral communication skills to collaborate and maintain positive working relationships with peers, leaders, surgery centers, and payer representatives to resolve credit balances.
- Consistent, regular, punctual attendance as scheduled is an essential responsibility of this position
- Other duties as assigned
Required Experience:
Qualifications and Education Requirements:
- High school graduate or equivalent.
- Must have the skills necessary to operate the office equipment required to fulfill job duties
- Excel, Word, Outlook
- Able to navigate through nThrive and Availity (preferred)
- Previous credit balance resolution experience in a facility or CBO environment
- 2 years combined experience CBO in Billing, Cash Collections, Denials, Disputes, Follow-up, and/or appeals
- Understanding of medical terminology
- Basic understanding of credit and refund guidelines
- Additional Notes
This is not an all-inclusive list. Additional tasks and responsibilities may be added by management based on business need.
