Refunds Processing Rep I

Major Responsibilities:

• Responsible for analyzing and resolving credit balances and requests for refunds within all AAH Hospital Billing entities and Professional Billing within multiple patient accounting systems and ensure appropriate contract reimbursement calculation rates are applied.
• Utilize multiple systems to review credit balances as assigned to determine the appropriate course of action needed to accurately resolve.
• Determine payor creating overpayment credit, verify coordination of benefits, reimbursement calculations and payment source and follow the appropriate system process and department procedures to resolve.
• Identify and report root cause of credit balances and payer refund trends; partner with internal and external counterparts.
• Document patient account notes and Guarantor account notes with all actions taken to resolve credit or refund requests.
• Possess knowledge of the Refund/Adjustment processes and utilizes systems/applications proficiently in order to resolve credit balances and process refunds appropriately. Contribute to improvement initiatives and department/system goals.
• Adheres to established Advocate Aurora Health Revenue Cycle policies, procedures, guidelines and productivity standards and responsible for maintaining personal growth and development.
• Responsible to read and understand all AAH Revenue Cycle policies and departmental policies and procedures.
• Assists level II's in completing ad hoc projects and related job activities as assigned to support department operations. During periods of high volume and/or impending deadlines, assignments may include assisting with patient accounting activities and functions typically performed by other Revenue Cycle positions.
• Acquires and maintains knowledge of all healthcare and insurance regulations, local, state, and federal legislation and regulatory agencies and activities which may affect Revenue Cycle operations.

Licensure, Registration, and/or Certification Required:

• None Required.

Education Required:

• High School Graduate.

Experience Required:

• Typically requires 1 year of experience in healthcare business office setting.

Knowledge, Skills & Abilities Required:

• Good organizational ability and communication skills (written and verbal).
• Ability to read, enter and retrieve information from multiple patient accounting systems.
• Basic understanding of Microsoft Office
• Basic bookkeeping skills and a strong mathematics aptitude.
• Able to work independently, under pressure in a fast paced environment.
• Strong attention to detail and maintains high degree of accuracy.
• Managed Care payer contract terms and Medicare/Medicaid payer guidelines.
• Ethical conduct.
• Regular and reliable attendance.

Physical Requirements and Working Conditions:

• Must be able to sit the majority of the workday.
• Exposed to a normal office environment.
• Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.