Credit Refund Representative

UCSF•San Francisco, CA

1d•$36 - $52

About The Position

The Credit/Refund Unit analyzes, reviews, and researches credit balances to determine appropriate refunds to various payees. It verifies the legitimacy of credit and refund requests from internal and external customers and processes refunds, adjustments, and fund transfers in accordance with established guidelines, policies, procedures, and regulatory requirements. The unit works closely with UCSF Medical Center's Accounts Payable department and affiliated institutions to ensure quality, accuracy, and compliance with UCSF, MGBS, government, and HIPAA standards. The Credit Refund Representative resolves outstanding credit accounts through ongoing communication with insurance payers, other MGBS units, UCSF clinical departments, and external billing agents. The role researches and resolves credit and refund discrepancies, handles all aspects of credit and refund processing, and maintains high standards of accuracy, quality, customer service, and regulatory compliance. This is a temporary six-month assignment with potential to extend.

Requirements

Minimum of 2–3 years of experience in a hospital or physician billing office, or an equivalent combination of education, training, and experience.
Flexibility to orient and work at all UCSF Medical Center locations.
Knowledge of CPT and ICD-9 or ICD-10 coding.
Experience with denials management and all aspects of billing and follow-up.
Proficiency in Microsoft Excel and Outlook.
Strong organizational, interpersonal, verbal, and written communication skills.
Ability to work effectively in a changing environment while managing multiple priorities and tasks.
Demonstrated time management skills, including prioritizing assignments and meeting deadlines.
Ability to work independently and collaboratively as part of a team.
Ability to consistently meet productivity and quality standards.
Strong customer service skills and a positive, professional attitude.
Demonstrated ability to coach and mentor staff to achieve optimal results.
Ability to establish priorities, goals, and objectives.
Excellent attendance and reliability.

Nice To Haves

Prior experience with the EPIC (APeX) system.
Certified Professional Coder (CPC) credential.
Associate's or bachelor's degree.

Responsibilities

Analyze and evaluate insurance claims with credit balances using a stratified approach, as assigned by management.
Research, review, and process insurance and patient credit balances according to established policies and procedures.
Research, review, and process insurance and patient refund requests according to established policies and procedures.
Coordinate with the Hospital regarding transfers of insurance and patient credit balances resulting from research and account reviews.
Accurately process and post refunds, adjustments, and journal transfers in accordance with applicable policies and procedures.
Apply knowledge of payer requirements and regulations, including PPO, EPO, HMO, and commercial insurance plans.
Communicate with insurance payers, patients, UCSF departments, and external billing agents to resolve credit balance and refund inquiries.
Use computer applications and information systems, including Microsoft Excel, Word, Outlook, APeX, and WebXtender, for research, refund processing, journal transfers, and payment posting.
Retrieve and verify account information to determine accurate credit balances and appropriate refund recipients.
Prepare refund check requests with supporting documentation and submit them to management for review and approval.
Communicate with insurance payers about payment takeback justifications and unidentified payment resolution.
Prepare and submit refund check request batches to Medical Center Accounts Payable for processing.
Research and process returned refund checks issued by MGBS, identifying and addressing reasons for their return.
Prepare batch summaries, organize supporting documentation, and maintain filing records.
Identify and communicate potential procedural changes and process improvement opportunities to management.
Participate in monthly Continuous Quality Improvement and Key Performance Indicator meetings, monthly one-on-one meetings, and unit and team meetings.
Perform special projects and other duties as assigned by the Assistant Manager or Manager.