Revenue Cycle Associate - Refunds
This position is responsible for the resolution of overpayments and/or credit balance account based on third party claim processing rules within established timelines. The Revenue Cycle Associate reports to the central business office supervisor or manager.
- Meets goals and objectives in assigned area;
- Complies daily with departmental policies and procedures;
- Performs reconciliation activity to ensure proper resolution and reimbursement on accounts;
- Provides thorough, courteous, and professional assistance to coworkers and patients;
- Ensures that all claims are resolved and meet all government mandated policies for Integrity and Compliance;
- Collaborates with hospital departments in the resolution of accounts;
- Resolves claims issues with third party payers and provide all required information timely; involves patients and family members (where necessary) to ensure timely resolution of claims with insurance companies;
- Researches, prepares, and submits appeals to insurance companies;
- Details all actions taken on account with clear and concise notes;
- Monitors and recognizes denials and/or issues that may be trends and escalate to management as needed; and
- Maintain strict confidentiality and adhere to all HIPAA guidelines/regulations.
Required Knowledge and Skills
- Knowledge of basic medical coding/terminology and third-party insurance operating procedures and practices a plus;
- Understands payer guidelines related to effective claim resolution;
- Knowledgeable and proficient with payer websites and other useful resources;
- Knowledge of revenue cycle and/or business office procedures;
- Highly detail oriented and organized;
- Ability to read, understand, and follow oral and written instructions; and
- Ability to establish and maintain effective working relationships and communicate clearly with customers and insurance companies both within and outside of Steward.