Oklahoma Arthritis Center
Refunds/Credit Balance Resolution Specialist
Oklahoma Arthritis Center, Edmond, Oklahoma, United States, 73034
Oklahoma Arthritis Center (OAC) is an Equal Employment Opportunity employer and considers all applicants without regard to race, religion, color, sex, national origin, age, disability, veteran status, or any other legally protected status.
Job Summary:
Under the general supervision of the Billing Services Manager, the Refunds/Credit Balance Resolution position is responsible for managing a specific portfolio of accounts involving credit balances and refund requests, ensuring timely and accurate resolution. This role requires collaboration with external customers-including third-party payers, patients/guarantors, estate representatives, attorneys, employers, and Oklahoma Arthritis Center (OAC) employees-and both contracted and non-contracted payers to facilitate prompt resolution.
Key Responsibilities:
Resolving insurance and patient overpayments, investigating refund requests, and addressing credit balance issues through detailed research of insurance benefits, claim processing, coordination of benefits, contractual obligations, and regulatory compliance. The role also works closely with the Payment Posting Specialist department to distribute, reapply, or transfer payments to the appropriate date of service or account, update account adjustments, generate refund requests, and review overpayment notifications or deny refund requests following established guidelines. The accuracy and timeliness of overpayment resolutions and refund requests depend on thorough knowledge of contractual terms and regulatory requirements
Essential Functions:
Responsible for credit balances, and requests for refunds for OAC and its affiliates. Conducts timely and accurate review of overpayments, credit balances and requests for refunds in the practice management system. Responsible for taking all steps necessary to facilitate prompt and accurate resolution of overpayments, credit balances and refunds payments including follow up with third party payers to determine coordination of benefits, insurance primacy rules and filing order. Effectively communicate to patients, insurance payers, related third parties and other Oklahoma Arthritis Center departments regarding billing and follow-up processes. Initiate refunds to patients/guarantors, insurance companies, and other third parties by following established refund procedures, contractual obligations, payer and regulatory requirements. Conduct timely and accurate review of refund requests for payers with contracted recoupment language to reduce future recoupment reconciliations. Responsible for reviewing, validating and correcting adjustments on accounts based on insurance reimbursement and coverage, contracted payers, and services provided. Validate and update patient demographic and insurance information to ensure accuracy of future claims. Work with Payment Posting Specialist team to correct posting issues as needed to clear accounts. Other duties as assigned by Administration. Assist co-workers as needed. Recognize when others are in need of assistance, information or directions and offers to help when able, or find someone who can. Responsible for neatness of work area to include stocking and cleaning. Be productive when faced with any "down time" during work hours. Maintain emotional control and diplomacy at all times. Maintain open and positive lines of communication. Consistently report to work on time, begins work promptly and perform duties for entire scheduled shift. Maintain absenteeism within company policy. Notify Administration of absences and tardiness in a timely manner. Read new policies and documents as instructed. Adhere to company policies and procedures. Demonstrate sensible and efficient use of equipment and supplies by limiting waste, spoilage or damage. Performance Requirements:
Knowledge:
Knowledge of medical billing and collection practices. Knowledge of basic medical coding. Knowledge of third-party payer operating procedures and practices. Knowledge of Medicare requirements. Skills:
Proficient skills in computer programs. Skill in trouble-shooting insurance claims and problems. Skill in establishing and maintaining effective internal and external working relationships. Abilities:
Ability to accurately enter data and examine insurance documents. Ability to deal courteously with patients, staff and others. Ability to communicate effectively and clearly. Qualifications:
A High School Diploma or GED required. A combination of six to twelve months of directly related training and/or billing experience in a health care organization is typically required for carrying out the responsibilities for this job. Physical Requirements:
Ability to work effectively in a fast-paced environment. Physical ability to sit, perform data entry and view computer screen for long periods at a time. Occasional exposure to communicable diseases and biohazards. Daily standing, walking, bending, and maneuvering. May require lifting up to 50 pounds or more to transfer and/or turn patient with and without assistive devices.
Travel: Travel may be required.
Scheduled Working Hours: Normal work hours are 8:00 a.m. to 5:00 p.m., Monday through Thursday and 8:00 a.m. to 1:00 p.m. on Fridays. Hours may vary depending upon the needs of the position, department, and clinic.
Other Duties:
Please note this job description is not designed to cover or to contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change from time to time, with or without notice.
Equipment Operated:
Standard office equipment including: computers, printers, faxes, copiers, postage machine, etc.
Job Summary:
Under the general supervision of the Billing Services Manager, the Refunds/Credit Balance Resolution position is responsible for managing a specific portfolio of accounts involving credit balances and refund requests, ensuring timely and accurate resolution. This role requires collaboration with external customers-including third-party payers, patients/guarantors, estate representatives, attorneys, employers, and Oklahoma Arthritis Center (OAC) employees-and both contracted and non-contracted payers to facilitate prompt resolution.
Key Responsibilities:
Resolving insurance and patient overpayments, investigating refund requests, and addressing credit balance issues through detailed research of insurance benefits, claim processing, coordination of benefits, contractual obligations, and regulatory compliance. The role also works closely with the Payment Posting Specialist department to distribute, reapply, or transfer payments to the appropriate date of service or account, update account adjustments, generate refund requests, and review overpayment notifications or deny refund requests following established guidelines. The accuracy and timeliness of overpayment resolutions and refund requests depend on thorough knowledge of contractual terms and regulatory requirements
Essential Functions:
Responsible for credit balances, and requests for refunds for OAC and its affiliates. Conducts timely and accurate review of overpayments, credit balances and requests for refunds in the practice management system. Responsible for taking all steps necessary to facilitate prompt and accurate resolution of overpayments, credit balances and refunds payments including follow up with third party payers to determine coordination of benefits, insurance primacy rules and filing order. Effectively communicate to patients, insurance payers, related third parties and other Oklahoma Arthritis Center departments regarding billing and follow-up processes. Initiate refunds to patients/guarantors, insurance companies, and other third parties by following established refund procedures, contractual obligations, payer and regulatory requirements. Conduct timely and accurate review of refund requests for payers with contracted recoupment language to reduce future recoupment reconciliations. Responsible for reviewing, validating and correcting adjustments on accounts based on insurance reimbursement and coverage, contracted payers, and services provided. Validate and update patient demographic and insurance information to ensure accuracy of future claims. Work with Payment Posting Specialist team to correct posting issues as needed to clear accounts. Other duties as assigned by Administration. Assist co-workers as needed. Recognize when others are in need of assistance, information or directions and offers to help when able, or find someone who can. Responsible for neatness of work area to include stocking and cleaning. Be productive when faced with any "down time" during work hours. Maintain emotional control and diplomacy at all times. Maintain open and positive lines of communication. Consistently report to work on time, begins work promptly and perform duties for entire scheduled shift. Maintain absenteeism within company policy. Notify Administration of absences and tardiness in a timely manner. Read new policies and documents as instructed. Adhere to company policies and procedures. Demonstrate sensible and efficient use of equipment and supplies by limiting waste, spoilage or damage. Performance Requirements:
Knowledge:
Knowledge of medical billing and collection practices. Knowledge of basic medical coding. Knowledge of third-party payer operating procedures and practices. Knowledge of Medicare requirements. Skills:
Proficient skills in computer programs. Skill in trouble-shooting insurance claims and problems. Skill in establishing and maintaining effective internal and external working relationships. Abilities:
Ability to accurately enter data and examine insurance documents. Ability to deal courteously with patients, staff and others. Ability to communicate effectively and clearly. Qualifications:
A High School Diploma or GED required. A combination of six to twelve months of directly related training and/or billing experience in a health care organization is typically required for carrying out the responsibilities for this job. Physical Requirements:
Ability to work effectively in a fast-paced environment. Physical ability to sit, perform data entry and view computer screen for long periods at a time. Occasional exposure to communicable diseases and biohazards. Daily standing, walking, bending, and maneuvering. May require lifting up to 50 pounds or more to transfer and/or turn patient with and without assistive devices.
Travel: Travel may be required.
Scheduled Working Hours: Normal work hours are 8:00 a.m. to 5:00 p.m., Monday through Thursday and 8:00 a.m. to 1:00 p.m. on Fridays. Hours may vary depending upon the needs of the position, department, and clinic.
Other Duties:
Please note this job description is not designed to cover or to contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change from time to time, with or without notice.
Equipment Operated:
Standard office equipment including: computers, printers, faxes, copiers, postage machine, etc.