DescriptionResponsible for timely research and resolution of insurance credit balances on highly complex cases. Performs necessary functions to refund overpayments from insurance carriers within 30 days of receipt. Manage work queues related to insurance overpayments and insurance credit balances. Identify trends, potential resolutions and escalate to manager. Evaluate accuracy of contract modeling, communicate findings, and escalate as appropriate. Responsible for reporting state Medicaid's credit balances on a quarterly basis. Participate in payer meetings to resolve issues. Responsible for ensuring solutions implemented and goals achieved. Identify and monitor CMS & payor rule changes and work to ensure compliance.QualificationsMinimum EducationBachelor's Degree (Preferred)Minimum Work Experience3 years Related patient accounting experience required, especially related to insurance overpayments trending and root cause analysis (Required)3 years Experience with reviewing and interpreting complex contract reimbursement methodologies and application to refunds. (Required)Required Skills/KnowledgeExcellent working knowledge of complex contract reimbursement methodologies including transplant, global, APR DRGs among others.Proven analytical skills including ability to make recommendations based on financial analysis.Excellent PC skills including advanced skill proficiency in Access and Excel spreadsheet analysis.Ability to work in a team environment with other analysts, managers, and department leaders.Proficiency in presentation of analytical results.Excellent working knowledge of coding & NCCI edits.Demonstrated knowledge of managed care payer requirements in an acute hospital setting.Demonstrated ability to facilitate team or group activities.Excellent verbal and written communication skills.Demonstrated ability to be flexible and to prioritize workload & decision-making skills.Ability to analyze workflow for process improvement.Strong organizational and coordination skills required.Functional AccountabilitiesAccount Follow-upEnsure all assigned claims and encounters are reviewed in a timely manner as per standard operating procedure (SOP)Evaluate contract management expected reimbursement and follow appropriate guidelines to report and escalate discrepanciesAssess overpayments and process timely as per proceduresRebill claim or issue refund as appropriate to facilitate payment retraction or refundEstablish a system to ensure refund requests from insurance carriers are processed within 30 days of receiptRead and interpret payer contracts for accuracy when submitting refund request for approvalEnsure appropriate supporting documentation is included with refundsReport state Medicaid's credit balances on a quarterly basisData Analysis and Issue ResolutionManage matrix of issues & resolutions including accountable stakeholders; ensure results and escalate issues as appropriate; regularly report updates and challenges to managerConduct root cause analysis of issues affecting overpayments. Identify key issues and assist in tracking, trending and reportingPresent data and analysis clearly to all levels of staff and managementMeet with manager and outside departments to review issues and develop action plansAssist in development of solutions, training & education guidelines to resolve issues and share data with staff and managementAppropriately engage and involve key accountable stakeholders in a collaborative mannerResearch payer & CMS policies related to revenue cycle; identify & alert stakeholders of required changes; track and ensure completionsOrganizational AccountabilitiesTrack RefundsMaintain a refund request log to monitor the request, issuance, mailing and posting of refunds.Provide supporting documentation to Accounts Payable with completed signatures and back up.Organizational Commitment/IdentificationPartner in the mission and upholds the core principles of the organizationCommitted to diversity and recognizes value of cultural ethnic differencesDemonstrate personal and professional integrityMaintain confidentiality at all timesCustomer ServiceAnticipate and responds to customer needs; follows up until needs are metTeamwork/CommunicationDemonstrate collaborative and respectful behaviorPartner with all team members to achieve goalsReceptive to others' ideas and opinionsPerformance Improvement/Problem-solvingContribute to a positive work environmentDemonstrate flexibility and willingness to changeIdentify opportunities to improve clinical and administrative processesMake appropriate decisions, using sound judgmentCost Management/Financial ResponsibilityUse resources efficientlySearch for less costly ways of doing thingsOrganizational Accountabilities (Staff)Organizational Commitment/IdentificationAnticipate and responds to customer needs; follows up until needs are metTeamwork/CommunicationDemonstrate collaborative and respectful behaviorPartner with all team members to achieve goalsReceptive to others' ideas and opinionsPerformance Improvement/Problem-solvingContribute to a positive work environmentDemonstrate flexibility and willingness to changeIdentify opportunities to improve clinical and administrative processesMake appropriate decisions, using sound judgmentCost Management/Financial ResponsibilityUse resources efficientlySearch for less costly ways of doing thingsSafetySpeak up when team members appear to exhibit unsafe behavior or performanceContinuously validate and verify information needed for decision making or documentationStop in the face of uncertainty and takes time to resolve the situationDemonstrate accurate, clear and timely verbal and written communicationActively promote safety for patients, families, visitors and co-workersAttend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performancePrimary Location: Maryland-Silver SpringWork Locations: Tech Hill 12211 Plum Orchard Drive Silver Spring 20904Job: Accounting & FinanceOrganization: FinanceRegular / Temporary: R (Regular)Position Status: FT - Full-TimeShift: DayWork Schedule: 8:30am - 5pmJob Posting: Oct 13, 2021, 6:44:47 AM