We have a great opportunity for a Refund Specialist to coordinate, investigate, file and notify claims that may fall under the guidelines for possible refunds.   In addition, you will be responsible for maintaining log of payments received and/or requested for both refunds and reinsurance, investigate claims for possible overpayments, initiate and submit refund request to the provider(s) and maintain confidentiality and comply with HIPPA guidelines. 

The following are intended to be examples of the accountabilities for which the person in this position is responsible.  This position is not intended to be complete or all-inclusive and does not preclude management from assigning other or related functions for which the individual has demonstrated competency through performance.

·         Requires the overall knowledge, skills and abilities to perform any functional role within Cash Management/Refunds.

·         Ability to research/identify issues and problems, develop solutions and prepare recommendations, including policies and procedures.

·         Interacts with supervisor or manager for approvals and actions needed to resolve outstanding refund requests.

·         Responsible for researching and resolving the following exception reports:  Remit Errors Report, Discrepancy Report, Provider Level Adjustment (PLB) and Multi Allow Error (MAE) Report by following the departmental policies and procedures.

·         Reconcile Credit Balance Report accounts.

·         Recommends operational changes to improve efficiency of department.

·         Notifies Supervisor/Manager on recurring issues and substantial dollars related to adjustments and/or refunds and any issues that impact production and quality.