Job Summary
The Refunds Specialist I processes refunds to patient and insurance accounts and prepares daily credit balance reports, using computer systems, databases and ledgers. Supports in the reconciling, correction, and/or completion of contractual adjustments, insurance refunds, and patient refunds. Responsible for Web based discrepancy refunds and RN lines to the logging system. Is flexible in work priorities and performs other duties as assigned.
As a Refunds Specialist I at Community Health Systems (CHS) - SSC Sarasota, you’ll play a vital role in supporting our purpose to help people get well and live healthier by providing safe, quality healthcare, building enduring relationships with our patients, and providing value for the people and communities we serve. Our team members enjoy a robust benefits package including medical insurance, dental insurance, vision insurance, PTO, 401K, sick time, holidays, and bonus where eligible.
Essential Functions:
Processes refunds to patient and insurance accounts. Maintaining appropriate knowledge and understanding of all Managed Care Contracts and Federal payors. Work overpayments, request for refund letters, faxes and telephone requests. Utilizes various computer systems and databases to completely analyze accounts. Reviews daily Credit Balance reports to analyze issues causing credit balances. Corrects contractual adjustment amount, if needed. Compiles refund request with appropriate documentation, if applicable. Ensures compliance procedure for prompt recording/processing of all refunds. Communicates any refund issues with the Reimbursement Manager/Supervisor as needed. Answer questions via email from the Facilities, TSSC Customer Service and PASI regarding credits, refunds, and account discrepancies. Statutes Government credit for reporting to Corporate. Identifies accounts to be escheated to the state. Monitors accounts for State Statue Waiting Periods Researches credit balance accounts to determine if a payor or patient has overpaid on the account. Prices claims using contracts, prices, and payment methodologies to validate refund requests from payors. Performs other duties as assigned. Complies with all policies and standards.
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Required: Education: H.S. Diploma or GED Experience: Accounts receivable experience in hospital or medical setting Preferred: Experience: Experience working with Managed Care Contracts preferred and Federal programs
Knowledge, Skills and Abilities:
To perform this job successfully, an individual should have knowledge of Word Processing software, Spreadsheet software and E-mail software.We know it’s not just about finding a job. It’s about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible.
The Sarasota SSC operates in support of our hospitals and patients and our commitment is to provide them with exemplary revenue cycle services defined by outstanding customer service and superior revenue cycle performance. SSC Sarasota support facilities located primarily in Florida, Georgia, Indiana, and Pennsylvania.
Community Health Systems is one of the nation’s leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.
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