Refund Proc Rep Ld

Advocate Health and Hospitals Corporation•Milwaukee, WI

2d•Remote

About The Position

This role assists leadership with workflows, quality audits, training, ad hoc reporting, complex research, delegating work, and team member coaching. The Refund Proc Rep Ld regularly performs non-routine tasks independently that significantly impact the organization. This position leads efforts to reduce all credit balances and refunds for all Advocate Hospital Billing entities and Professional Billing within multiple patient accounting systems, ensuring appropriate contract reimbursement calculation rates are applied. The role recommends and implements process enhancements, monitors account follow-up, and ensures timely processing of credits and refunds while acting as a resource to all team members and external partners. This role also works with leadership, level II's, operations, and the Revenue Cycle Process Designer as needed to update or draft workflow updates. The Refund Proc Rep Ld reads, interprets, and understands insurance correspondence including both explanation and coordination of benefits. They provide individual contributions to meet or exceed department goals by consistently meeting individual productivity and quality standards and targeted error ratios in processing credit balances. This role also assists with patient accounting activities and functions typically performed by other Revenue Cycle positions during periods of high volume or impending deadlines. They coordinate to resolve issues requiring in-depth follow-up with leadership, physicians' offices, insurance companies, attorneys’ offices, or other internal departments while maintaining knowledge of insurance regulations and payer policies.

Requirements

High School Graduate
Typically requires 5 years of experience in healthcare business setting.
Strong skill set in problem-solving across various settings, with critical analytical and investigation skills.
Ability to motivate and direct team members' work and activities, including effective delegation.
Demonstrates strong verbal, written, and interpersonal communication, with excellent grammar and spelling.
Sets the climate for performance expectations and fosters a positive team environment.
Pays attention to detail and maintains a high degree of accuracy.
Exceptional time management and project management techniques, working efficiently under strict deadlines.
Willingly accepts responsibility and applies appropriate leadership techniques in an operational setting.
Proficient understanding of Microsoft Office.
Strong knowledge of Managed Care payer contract terms and Medicare/Medicaid payer guidelines.
Upholds ethical conduct in all activities.
Regular and reliable attendance.
Must be able to sit the majority of the workday.
Operates all equipment necessary to perform the job.

Nice To Haves

None Required.

Responsibilities

Assists leadership with workflows, quality audits, training, ad hoc reporting, complex research, delegating work, and team member coaching.
Regularly performs non-routine tasks independently that significantly impact the organization.
Delegates assignments from vendor, audit, and compliance projects, ensuring completion within the appropriate time frame.
Conducts high-level analysis of other team members' transactions before releasing them to payees or for next-level approval.
Ensures continuous improvement by applying various experiences to look beyond issues and uncover the underlying causes of problems, credits, and refunds.
Demonstrates a sense of ownership by providing solutions to critical issues and regularly engaging with peers and external partners as needed.
Demonstrates expert-level knowledge of the Refund/Adjustment processes and utilizes systems/applications proficiently to resolve credit balances and process refunds appropriately.
Approaches high-level problems from different angles, identifies ways to mitigate risks, and develops concrete solutions with little or no precedent.
Leads efforts to reduce all credit balances and refunds for all Advocate Hospital Billing entities and Professional Billing within multiple patient accounting systems, ensuring appropriate contract reimbursement calculation rates are applied.
Recommends and implements process enhancements, monitors account follow-up, and ensures timely processing of credits and refunds while acting as a resource to all team members and external partners.
Works with leadership, level II's, operations, and the Revenue Cycle Process Designer as needed to update or draft workflow updates.
Reads, interprets, and understands insurance correspondence including both explanation and coordination of benefits.
Provides individual contributions to meet or exceed department goals by consistently meeting individual productivity and quality standards and targeted error ratios in processing credit balances.
Assists with patient accounting activities and functions typically performed by other Revenue Cycle positions during periods of high volume or impending deadlines.
Coordinates to resolve issues requiring in-depth follow-up with leadership, physicians' offices, insurance companies, attorneys’ offices, or other internal departments while maintaining knowledge of insurance regulations and payer policies.

Benefits

Comprehensive suite of Total Rewards: benefits and well-being programs
Competitive compensation
Generous retirement offerings
Programs that invest in your career development
Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program