Refund Specialist

**Fully Remote, Contract-to-Hire - Can Sit Out of Any State**

**All Equipment Provided by DaVita**

**Must Be Able to Pass Full 10 Panel Drug Screen (Cannot have THC in Their System)**

Schedule: M-F, Flexible 8-Hour Shift (Can start as early as 6:00am PST and as late as 9:00am PST), 30 minute lunch


Overview:

We are currently looking for a Credit Balance Specialist for 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 to prevent future rework. In this position, you will analyze EOBs and/ or payor correspondence to reconcile system credit balances or potential over-payments, 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 position available. All necessary equipment is provided.

Essential Duties:

Overview:
-Position is REMOTE - we can pull from anywhere in the United States!
**Ability to work independently and finding the root cause of what's going wrong with a claim, and ensure that it is being reimbursed correctly
-Billing/collections candidates can work, although they'd prefer credit specialists that have worked on the reimbursement side of revenue cycle
**Working with credit balances and experience refunding payers
-Ability to determine reimbursement methodology - how are they going to pay and what are the challenges
-Familiarity with a variety of insurances and ability to work with different payers
**Depending on the financial class they're in, 20-25 claims per day minimum
Quality needs to be held to 95%

**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 refunds, 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 and analytical problem solving skills to resolve issues
-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.
-Supports monthly reporting of outstanding credit balances

*Experience not just preparing for refunds, but actually processing refunds when an overpayment/underpayment has been made.
*Root cause analysis - doing research on the account and understanding what went wrong during the billing process that resulted in the payers either over or under paying the claim.
*Working with a variety of insurances and being extremely tech savvy on portals.
*Having a background in full cycle is helpful - billing/collections/payment posting
▪ Preformed retractions and claim adjustments on both Medicaid and Medicare web portals.
▪ Claim account review and analysis to identify overpayments.
▪ Processed refunds/retractions to insurance and patients related to overpayments.
▪ Resolved Special Projects for other teams and Management in the department.
▪ Building power points, pivot tables, and data charts.
▪ Worked with a variety of data platforms and systems as well as provider web portals.
· Communicate with insurance payers to ensure proper insurance coverage for patients or to ensure timely and accurate reimbursement for dialysis services rendered at clinics.
· Assist in resolving discrepancies between AMII and DAX billing systems to ensure accurate claim information.
· Analyze, assess impact, resolve, and escalate concerns involving accurate billing and revenue capture.

Qualifications

High School Diploma or equivalent required
5+ years' experience with accounting, transactions or medical billing systems a plus
Health care and medical billing/collections/over-payment remediation or experience is preferred
Knowledge or experience working with a variety of health care insurance payers is preferred
Intermediate computer proficiency in Microsoft Office including Excel and Outlook


Interview Expectations:

-One-and-Done with the hiring leaders
-All 30 minute virtual interviews via WebEx links.
-Expectation is that their camera is on and they are on time for the interview, not early.
If there is any discomfort at all about using WebEx, PLEASE let's work with the talent to test out their setup and ability to interact on WebEx. We can create a profile and personal rooms for them to join if necessary to make sure they are comfortable navigating the platform.
Req Sheet

Selling Points
-Growth Opportunity

-Internal Promotions

-Fully Remote

3-5 Must Have Skills/Qualifications:
-Credit Analysis
-Over-Payment Remediation
-Microsoft Office Proficiency
-EOB Knowledge
-25-30 Claims Daily

Nice to Have Skills:
-Independence
-Multitasking


Schedule/Shift
M-F, Flexible 8-Hour Shift (Can start as early as 6:00am PST and as late as 9:00am PST)

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