Refund Dispute Specialist

Refund Dispute Specialist

Requirements

• High School diploma/GED or equivalent required; some college a plus
• A minimum of one to two (1-2) years of experience in revenue cycle management with a working knowledge of Managed Care, Commercial, Government, Medicare, and Medicaid reimbursement
• Working knowledge of automated billing systems; experience with CPR+ and Waystar a plus
• Working knowledge and application of metric measurements, basic accounting practices, ICD 9/10, CPT, HCPCS coding, and medical terminology
• Solid Microsoft Office skills with the ability to type 40+ WPM
• Strong verbal and written communication skills with the ability to independently obtain and interpret information
• Strong attention to detail and ability to be flexible and adapt to workflow volumes
• Knowledge of federal and state regulations as it pertains to revenue cycle management a plus

Responsibilities

• Reverses or completes necessary adjustments within approved range. Ensures daily accomplishments by working towards individual and company goals for cash collections, credit balances, medical records, correspondence, appeals/disputes, accounts receivable over 90 days, and other departmental goals
• Understands and adheres to all applicable state/federal regulations and company policies
• Understands insurance contracts in terms of medical policies, payments, patient financial responsibility, credit balances, and refunds
• Verifies dispensed medication, supplies, and professional services are billed in accordance to the payer contract. Validates accuracy of reimbursement and the appropriate deductible and cost share amounts billed to the patient per the payer remittance advice.
• Reviews remittance advices, payments, adjustments, insurance contracts/fee schedules, insurance eligibility and verification, assignment of benefits, payer medical policies and FDA dosing guidelines to determine if a refund or dispute is needed. Completes payer/patient refunds as needed and validates receipt of previously submitted refunds/disputes.
• Creates payer dispute letters utilizing Amerita’s standard dispute templates and gathers all supporting documentation to substantiate the dispute. Submits disputes to payers utilizing the most efficient resources, giving priority to electronic solutions such as payer portals. Scans and attaches disputes to patient’s electronic medical record in CPR+.
• Works closely with intake, patients, and payers to settle coordination of benefit issues. Communicates new insurance information to intake for insurance verification and authorization needs. Submits credit rebill requests as needed to the billing department or coordinates patient-initiated billing efforts to insurance companies.
• Initiates and coordinates move and cash research requests with the cash applications department.
• Utilizes approved credit categorization criteria and note templates to ensure accurate documentation in CPR+
• Works within established departmental goals and performance/productivity metrics
• Identifies and communicates issues and trends to management

Preferred Qualifications

• Flexible schedule with the ability to work evenings, weekends, and holidays as needed