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Description:

• Responsible for timely and accurate resolution of credit balance accounts, refund or takeback requests.
• Completes knowledge of insurance processes, coordination of benefits, claims processing, state and federal Statutes regarding overpayment regulations.
• Reviews and analyzes accounts and/or reports from insurance companies and patients to facilitate the resolution of credit balance accounts.
• Utilizes available resources to review payment discrepancies and identify trends/reasons for future discussion.
• Proactively identifies, researches and resolves unusual, complex or escalated issues, as necessary. Escalates ongoing issues or concerns to management.
• Documents all activities and findings in accordance with established policies and procedures; ensures the integrity of all account documentation; maintains confidentiality of medical records.
• Meets quality assurance and productivity standards through identification, reconciliation of credit balance accounts and review of credit balance reports for potential overpayments in accordance with organizational policies and procedures.
• Maintains current knowledge of internal, industry, and government regulations as applicable to assigned function.
• Works with payers, Payer Contracting, RCM leadership, Finance, and any other team members in resolving credit balance issues.
• Completes due diligence on all refund requests to ensure that request is valid and accurate in terms of payer contractual and proper documentation.
• Processes adjustments for accounts with credit balances that have occurred due to posting corrections, write-off’s, rate changes.
• Prepares refund packages with all supporting documentation and obtain required signatures for approval.
• Serves as a dedicated resource person to answer questions pertaining to credit balance.
• Recommends and identify overpayment trends for future billing and collection improvement.
• Adapts quickly to frequent process changes and improvements.
• Is reliable, engaged, and provides feedback as to improve processes and policies.
• Attends all department, team, and company meetings as required.
• Meets company quality standards.
• Embraces and exemplifies ADS core values:

• May perform any additional responsibilities or special projects as required.
• Duties and responsibilities may be subject to change based upon the needs of the department.
• May provide cross-functional support as business needs demand.

Requirements:

• High School diploma or equivalent
• 3-5 years experience in medical revenue cycle with previous posting and remittance experience
• Knowledge of general concepts and practices that relate to the healthcare field, and specific policies, standards, procedures and practices that pertain to the assigned function.
• Knowledge of the insurance follow-up process for government and non government payers, including the CMS 60-day overpayment rule.
• Knowledge of insurance company contract rates
• General computer skills, typing skills, and a working knowledge of Medicare, Commercial Payer, and HIPAA Compliance
• Basic understanding of accounts receivables in a healthcare setting
• Basic math and business calculations
• Working knowledge of computer/data entry with the ability to learn new systems
• Basic level of MS Office proficiency

• Friendly, professional, and effective communications skills; able to calmly present solutions in challenging situations.
• Proactive identification of challenges, and solution-oriented approach to problem solving.
• Service-orientation and aptitude to aptitude to resolve insurance and/or patient matters.
• Effective analytical skills: able to use inductive and deductive reasoning to anticipate outcomes.
• Self-directed accountability and reliability
• Effective communication, and interpersonal skills, with the ability to influence and collaborate effectively with cross-functional teams.
• Able to manage and prioritize multiple tasks/projects, work autonomously, and meet deadlines.
• Able to work well in a team environment that promotes inclusiveness and communication among team members.
• Communication using both verbal and written English proficiency.
• Cultural competence

• Candidates must successfully pass a background check.
• Candidates must be able to provide proof of eligibility to work in the United States without sponsorship.

• Health, Dental & Vision options
• FSA and HSA plan with Employer Contribution
• Employer paid EAP
• 401k with 4% Company Match
• Discretionary Profit-Sharing Plan
• Paid Time Off (PTO) Including 7 Paid Holidays and a Birthday Holiday
• On-Site Gym
• In-house Training Programs
• A fun culture in a fast-growing organization!

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.