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Remote Medical Refunds Specialist

Lensa

Fort Smith (AR)

Remote

USD 35,000 - 55,000

Full time

3 days ago

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Job summary

An established industry player in healthcare is seeking a detail-oriented Medical Specialist to manage refunds and account adjustments. This entry-level role involves processing refunds for patients and insurance accounts, ensuring compliance with contractual obligations, and utilizing various computer systems for data analysis. The ideal candidate will have a High School Diploma and some experience in accounts receivable, particularly in a medical setting. Join a dynamic team and contribute to improving financial processes in a supportive work environment.

Qualifications

1-3 years of accounts receivable experience in a hospital or medical setting.
Knowledge of Managed Care Contracts and Federal programs preferred.

Responsibilities

Processes refunds to patient and insurance accounts.
Analyzes accounts using various computer systems and databases.
Ensures compliance with procedures for prompt recording and processing of refunds.

Skills

Accounts Receivable Management

Communication Skills

Knowledge of Managed Care Contracts

Data Analysis

Education

High School Diploma or GED

Tools

Word Processing Software

Spreadsheet Software

Email Software

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Job Summary

Processes refunds to patient and insurance accounts and prepares daily credit balance reports using computer systems, databases, and ledgers. Supports in reconciling, correcting, and completing contractual adjustments, insurance refunds, and patient refunds. Responsible for web-based discrepancy refunds and RN lines to logging system. Flexible in work priorities and performs other duties as assigned. Working hours are Monday-Friday, 8:00 am - 4:30 pm CST.

Essential Functions

Processes refunds to patient and insurance accounts.
Maintains knowledge of all Managed Care Contracts and Federal payors.
Handles overpayments, refund requests via letters, faxes, and phone calls.
Uses various computer systems and databases to analyze accounts.
Reviews daily Credit Balance reports to identify issues, corrects contractual adjustments if needed, and compiles refund requests with documentation.
Ensures compliance with procedures for prompt recording and processing of refunds.
Communicates refund issues with Reimbursement Manager/Supervisor as needed.
Responds to emails from Facilities, TSSC Customer Service, and PASI regarding credits, refunds, and discrepancies.
Reports government credits to Corporate.
Identifies accounts to be escheated to the state.
Monitors accounts for State Statute Waiting Period.
Researches credit balance accounts for overpayments by payors or patients.
Validates refund requests using contracts, pricers, and payment methodologies.
Performs other duties as assigned.
Complies with all policies and standards.

Qualifications

High School Diploma or GED required.
1-3 years of accounts receivable experience in a hospital or medical setting required.
Experience with Managed Care Contracts and Federal programs preferred.

Knowledge, Skills, and Abilities

Knowledge of Word Processing, Spreadsheet, and Email software.

Equal Employment Opportunity

Community Health Systems does not discriminate in employment based on race, color, religion, sex, sexual orientation, genetic information, gender identity, national origin, age, disability, citizenship, veteran status, or military service. We comply with all applicable laws. Applicants with disabilities needing accommodations should contact Human Resources.

Additional Details