Job Description

Job Title: Refund Specialist: Insurance Claims
Location: 3201 S 323rd St, 06998 Federal Way, WA 98001
Duration: 6+ Months

Job Description:

currently looking for a Refund Specialist for our Credits Team in our Revenue Operations Department.
Individuals who excel in this role are highly ambitious, results-driven, and willing to "think outside the box."
This position requires a high level of attention to detail and the ability to work well as part of a fast-paced team.
The ideal candidate has a high level of multitasking abilities, strong mathematical and analytical skills, and is driven by resolving open balances with the goal of preventing future rework.
In this position, you will analyze EOBs and/ or payor correspondence to reconcile system credit balances or potential overpayments, research and resolve problem accounts, and request adjustments.
You will effectively identify trends and analyze root causes to drive work efficiently within the team.
Hybrid and remote positions are available.
All necessary equipment is provided.

Essential Duties and Responsibilities:

Autonomously research, initiate follow-up and resolve all health care insurance claim accounts with existing credit balances (claim(s) paid more than expected by payer); actions included but not limited to initiating refund packets, retractions, and/or adjustments to claims
Navigate through various payer systems and multiple internal systems to ensure timely and accurate resolution of claims
Use critical thinking, root cause analysis, and problem-solving skills to resolve issues on outstanding claim balances
Uses strong organizational skills to effectively manage large amounts of detailed information
Utilizes excellent written and oral communication skills to collaborate and maintain positive working relationships with peers, leaders, clinical personnel, and payer representatives to resolve credit balances.
Contribute to the implementation of process improvement initiatives aimed at improving the credit department
Ensures compliance by using established internal control procedures by examining records, reports, operating practices, and documentation
Stay current on communications relating to healthcare reimbursement and regulatory changes
Maintain confidentiality of all company and patient information in accordance with HIPAA regulations and policies
Understand and adhere to all policies, laws, and regulations applicable to this role
Consistent, regular, punctual attendance as scheduled is an essential responsibility of this position
Participate in group settings and teamwork environment

Qualifications:

High School Diploma or equivalent required
Healthcare and medical claim overpayment remediation and refunding experience is required
2-4+ years’ experience with accounting, transactions, or medical billing/accounting systems required
Knowledge or experience working with a variety of health care insurance payers is preferred
Intermediate computer proficiency in Microsoft Office including Excel and Outlook- required

What We’ll Provide:

All necessary workstation equipment
At ***, we strive to be a community first and a company second. We want all teammates to experience *** as "a place where I belong."
Our goal is to embed Diversity & Belonging into everything we do in our Village so that it becomes part of who we are.
We are proud to be an equal-opportunity workplace and an affirmative-action employer.
As such, individuals are recruited, hired, assigned, and promoted without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, protected veteran status, or any other protected characteristic.

Schedule: Hourly Monday- Friday 8 hour shift, 40 hours per week (includes a clocked out 30 minute lunch every day) – OT not available except upon Leadership approval for special circumstances/projects

First 120 days:

PST: 8 am – 4:30 pm
MST: 8:30 am – 5 pm (7:30 – 4 PM PST)
CST: 8:30 am – 5 pm (6:30 am – 3 pm PST)
EST: 9 am – 5:30 pm (6 am -2:30 pm PST)
120 days subject to change based on approval and meeting metric and performance expectations autonomously

Work Environment: