Rev Cycle Specialist (Refunds)

Description Summary: Process refunds for patients and unclaimed properties to escheat to State. Able to review accounts and apply credits to open balances within systems. Essential Functions and Responsibilities: Review overpaid accounts through requests from systems, patients, and insurance companies. Review posting errors. Work to identify any unclaimed property to escheat to different states. Review spreadsheets sent from third-party overpaid companies of accounts not claimed. Review all correspondence from insurance to determine if the refunds requested show both the payer's payments and to determine overpaid accounts and payment errors. Review CMS requests for recoups and payer errors for redetermination. Adheres to compliance with CMS and other payer guidelines. Ensure confidentiality of all patient accounts by following HIPAA guidelines Works to identify and resolve payment posting issues. Performs other duties as assigned for medical records, and payment posters. Assist in Medical records auditors that come to the CBO location meet and greet. Assist in Sending Medical Records as requested by insurance carriers. Attends in-services, education sessions, and department meetings as scheduled. Maintains a working knowledge of all Prism systems (e.g. Athena, MDI, Teams, ModMed, Navinet) Able to review Excel spreadsheets and modify reports as needed. Work with Accounts payable for release of checks to be mailed for refunds. Assist and back up payment posters desk which includes pulling payments of portals to upload to systems. Essential Qualifications: Education: High School Diploma Experience: 3-5 years’ experience in refunds, medical billing, claims process. Back-end billing experience within Ophthalmology preferred but not required. Knowledge/Skills/Experience: Knowledge of ICD-9, ICD-10, CPT codes and procedures Ability to work independently and to work collaboratively on projects Ability to interface with management and co-workers Ability to create channels of communication to obtain information necessary to perform job tasks, such as with clients, payers, clinical staff and billing department staff Ability to recognize individual and system problems and to communicate such information to the supervisor Excellent written and verbal communication skills Outstanding attention to detail and excellent time management skills Outstanding computer skills with billing software, Microsoft Word and Microsoft Excel, able to learn our system, good typing skills Experience with Medicare, insurances, claims, appeals Ability to work with proprietary information, PHI, ePHI, etc., while maintaining confidentiality at all times

Salary : $43,000 - $66,000