Job Description

Job Description

Processes refunds to patient accounts and prepares daily credit balance reports, using computer systems, databases and ledgers. Responsible for Web based discrepancy refunds and RN lines to logging system. Assists manager with month end reporting. Is flexible in work priorities and performs other duties as assigned. Serves as lead for the refunds team and participates in training of new staff.

* Processes refunds to patient accounts, maintaining appropriate knowledge and understanding of all Managed Care Contracts and Federal payors. Work overpayments request for refund letters, faxes and telephone requests.
* Utilizes computer systems and databases.
* Prepares daily Credit Balance reports. Analyzes issues causing credit balances. Corrects contractual adjustment amount if needed. Compiles refund request with appropriate documentation.
* Performs the quarterly Medicare Credit Balance review and Escheat Report. Pulls EOB's and required documentation to accurately prepare refunds for processing.
* Ensures compliance procedure for prompt recording of all refunds.
* Coordinates any refund issues with Reimbursement Manager/Supervisor and Reimbursement Specialists as needed.
* Sets priorities to meet departmental needs.
* Completes productivity reports weekly, monthly as required timely.
* Balance and clear the withholding GLs for all SSC supported hospitals.
* Clear the Insurance Unapplied accounts for 8 hospitals.
* Facilitate and organize all audits and projects.
* Answer questions via e-mail from the Facilities, TSSC Customer Service and PASI regarding credits, refunds, offsets, GLs and account discrepancies. These are not limited to my 4 assigned Facilities.
* Review all offsets submitted by the Collectors for all 12 hospitals to determine if the money is in the Withholding or needs to be posted by the posting staff.
* Review all negative/offset remits from the Correspondence for all 12 hospitals for the posting staff.
* Answer any training/refund questions presented by my 3 trainees and 2 seasoned Refund Representatives.
* Write step actions for various refund procedures, adjustment sheet and payment transfer procedures.
* Process all Patient Balance Transfer forms for all hospitals.
* Takes sense of ownership regarding other related duties as assigned.