What are the responsibilities and job description for the Payment Auditor/Refund Specialist position at Natchitoches Regional Medical Center?
Description
Position Summary
The primary responsibility of the Payment Auditor/Refund Specialist is review of Insurance Payments or posting of account adjustments for subsequent patient liabilities (deductible, copayment, coinsurance amounts) to ensure accurate patient balance for hospital-based accounts prior to statement generation. During the process, ensures that denial activity is routed to respective billing associate for timely follow-up. Reviews credit balance accounts for subsequent billing adjustments, contractual adjustments or refund requests to insurance companies or patients. Builds and maintains positive relationships with Finance and Business Office Associates to maintain acceptable credit balance levels according to direction of Leadership.
Primary Responsibilities
Reasonable accommodations may be made to enable individuals with disabilities to perform the primary responsibilities.
- Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations.
- Audits payments from insurance companies daily and takes appropriate, timely actions to:
- Ensure patient balance is accurate prior to assignment to early out vendor for patient collection activity.
- Send reminder to appropriate biller for timely follow-up on denial activity.
- Makes patient adjustments based on patient status for financial assistance or discount.
- Audits credit balance accounts to determine account balance accuracy and makes appropriately authorized adjustments.
- Coordinates refund requests with required supporting documentation to Finance. Posts refund transactions in patient accounts to maintain account integrity.
- Maintains clear, concise documentation of all actions taken on accounts.
- Other special projects or job duties as required by management.
Competencies
- Excellent financial acumen and written communication skills.
- Strong organizational, interpersonal and critical thinking skills.
- Ability to work independently with minimum supervision.
- Must be able to multi-task and prioritize workload and pay meticulous attention to detail.
- Proficient in Microsoft Office software programs (Word, Excel, and PowerPoint).
Supervisory Responsibility
None.
Requirements
Required Education and Experience
- High School Diploma required.
- Extensive knowledge of Insurance payment methodologies related to interpreting Remittance Advice and/or Explanation of Benefits.
- 3 years of health care experience in healthcare billing.
- Excellent Financial acumen.
