Credit Balance and Refund Specialist

Description

About Our Company

Advanced Diabetes Supply® was founded on the bold principle of creating a knowledgeable, reliable and demonstrably superior diabetes supply company. Our approach, coupled with a commitment to service and innovation, has catapulted Advanced Diabetes Supply® to a national leader in the industry. Creating high-performance, adaptive teams requires a relentless commitment to hiring the best. We strive to maintain a casual, fun environment whenever possible, but we don’t just play around. We work hard every day to provide a positive work culture and respectful atmosphere. The standards we set for ourselves are high, and we love to be challenged! If you enjoy working in a collaborative environment, have a passion for excellence and a bias for action, we may be just what you’ve been looking for.

Interested in learning more about our company and its culture? Visit us at www.northcoastmed.com

About The Position 

Hours - 8:00 AM -4:30PM ET

Location - Hybrid- Doral, FL 

Position Summary 

The RCM Credit Balance and Refund Specialist resolves credit balance accounts for third-party payers and patients by reviewing claims, payments, and denials while ensuring compliance with industry standards. This role requires a strong understanding of payor requirements, contracts, and claims processing to maintain accuracy and exceed customer expectations.

  Essential Functions 

• 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:

                o We put our people first.

                 o We serve our members with passion

                 o We take ownership

                 o We pursue excellence

                 o We never stop growing

 Other Responsibilities 

• 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 go