Our client is seeking a Medical Refund Analyst to support their department. This is a contract to hire role, offering $22-$24 hourly, and is on a 5 day in office work schedule.
Role: Medical Refund Analyst
Location: Plano, TX 75024
Pay Rate Range: $ 22 – $ 24 / hour
Job Duties:
- Primary responsibility for the daily processing of third party and patient refund utilizing a credit balance report, correspondence or incoming calls.
- Review and research patient accounts with credits and submit refund if necessary.
- Research A/R for unsolicited and solicited refunds and overpayments, along with tracking and documenting request.
- Send dispute or appeal on any refund request received that is not valid or true.
- Identify the originating cause of the refund and compile a report of recurring issues to management.
- Generate refund and overpayment letters documenting request and resolution to be sent to the payors.
- Prepare refund request form and supporting documentation regarding overpayment calculations.
- Key refund approvals into the system, also compile and send the necessary documentation to accounts receivable for refund check processing.
- Validate all request from third party payors for refund, ensuring they are valid in accordance to our contractual obligation and meet governmental requirements.
- Contact third party payers, employers, state agencies and patients to help determine resolution.
- Review each assigned account to ensure that the account balance is accurate, verifying that all correct steps have been completed by the previous departments to ensure that no billing/claim errors have occurred and the balance on the account is correct. Ensure that remaining variances are categorized as a potential over or underpayment.
- Research returned or un-cleared refunds checks and take the necessary action to resolve.
- Verify the contracted rates and compare them with the insurance payment when the payor (insurance) is contracted with the hospital. Appeal variances to the insurance company according to the contracted rates. For non-contracted payors, ensure the payor knows that the total claim charge is remitted.
- Complete manual adjustments, contract overrides and allowances as needed for accounts in which the system cannot properly adjudicate, including debit and credit balances.
- Consult with Managed Care to review unclear contract language.
- Submit requests to update systems timely upon rate change effective dates as needed
- Re-prorate accounts through systems for corrected pricing, including debit and credit balances.
- Complete daily credit balance review. Update status of accounts and submit to appropriate person for refund completion.
- Obtains approval prior to posting and accurately posts all zero pay remits in which payments are applied to an over pay.
- Complete all requests required for audits timely.
- Complete all post payment variance reviews within 3 days of payment on both interim and admit to discharge account payments.
- Develop analytical reports needed to complete credit reviews.
Qualifications:
- 2+ years experience in refunds/adjustment
- Experience with hospital accounts
Why choose Addison Group?
- Pay: We negotiate high salaries using the US Bureau of Labor Statistics.
- Benefits & Bonuses: You are eligible for medical, dental, vision insurance benefits, and 401k.
- Permanent Employment: Many of Addison’s job openings lead to potential permanent employment.
- Connections: You connect directly with hiring managers.
- Options: You are presented multiple employment options near your home.
- Professional Development: You are provided hiring process advice, resume revision, and employment term negotiation
- Equipment Provided
Addison Group is an Equal Opportunity Employer. Addison Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Addison Group complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. Reasonable accommodation is available for qualified individuals with disabilities, upon request.