Refund Analyst Lead
About The Position
Under the supervision of the Refund Analyst, the Refund Analyst Lead is responsible for providing operational support and training to the Reimbursement/Refund Analyst team including rounding with staff, triaging issues and offering solutions. Additionally, they will assist supervisor with special projects including but not limited to providing timely and efficient follow-up with all payer types for all overpaid claims, consistent with the Mission and Philosophy of Dignity Health Medical Foundation. Demonstrates a solid understanding of your role as a Refund Analyst Lead. Payer Rules & Regulations Understand Contract Language/Division of Financial Responsibility Coordination of Benefit rules Understand Offsets & Recoupments Read & interpret invoice details Patient registration in IDX Rejection posting in IDX Knowledge of medical records systems Ability to navigate Insurance payer web sites Read & interpret EOB & from various insurance carriers FSC knowledge Rules of FSC Flipping Rules of Charge Corrections. Understanding of claim edits Acts as main point of contact for Refund Analyst staff and assists supervisor in resolving operational issues. Triages issues with staff and offers solutions. Mentors and coaches Refund Analyst staff and provides constructive feedback Takes initiative to find opportunities for process improvement within the department Provides in-depth analysis of inventory to identify possible system issues, payer trends and areas for internal staff and Clinic Operations training development. Has the ability to independently research and resolve complex and/or escalated issues with available resources and tools Utilizes appropriate chain of command to assist in resolving complex issues after necessary research has been completed Under the supervision of the Revenue Integrity Supervisor, responsible for assisting with the research and resolution of all outstanding credit balances, ensuring timely and accurate processing. Timely review of electronic communication to stay informed of changes that affect your position. Has the ability to manage multiple expectations, tasks and deadlines effectively. Assists with audits as needed Trains Refund Analyst Staff on workflows and processes as needed. Proactively organizes and manages caseload to ensure timely follow through on credits. Assists with special projects and tasks as assigned from Leadership Team.
Requirements
- High School Diploma or GED
- Six years’ experience working in healthcare revenue cycle and/or a professional medical billing office
- One-year experience with IDX Practice Management System
- Knowledge of physician billing regulations
- Understanding of professional claims, billing procedures and reimbursement terms
- Excellent interpersonal and organizational skills
- Working knowledge of computers and demonstrated proficiency in using e-mail systems, Internet and office software applications
- Knowledge of Google sheets
- Strong MS Excel skills to interpret and analyze high volume of data
Nice To Haves
- Associates in Health Care Administration or related field
- One year experience with Cerner EHR
Responsibilities
- Provide operational support and training to the Reimbursement/Refund Analyst team
- Triage issues and offer solutions
- Assist supervisor with special projects
- Provide timely and efficient follow-up with all payer types for all overpaid claims
- Act as main point of contact for Refund Analyst staff and assists supervisor in resolving operational issues
- Mentor and coach Refund Analyst staff and provides constructive feedback
- Take initiative to find opportunities for process improvement within the department
- Provide in-depth analysis of inventory to identify possible system issues, payer trends and areas for internal staff and Clinic Operations training development
- Independently research and resolve complex and/or escalated issues with available resources and tools
- Assist with the research and resolution of all outstanding credit balances, ensuring timely and accurate processing
- Assist with audits as needed
- Train Refund Analyst Staff on workflows and processes as needed
- Proactively organize and manage caseload to ensure timely follow through on credits
- Assist with special projects and tasks as assigned from Leadership Team
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
