Refund Proc Rep Ld

American Addiction Centers • Milwaukee, WI

2d • $24 - $36 • Remote

About The Position

This is a full-time position working 40 hours per week, Monday through Friday from 7:00 am to 3:30 pm. The role is remote. The Refund Processing Representative Lead assists leadership with workflows, quality audits, training, ad hoc reporting, complex research, delegating work, and team member coaching. This role regularly performs non-routine tasks independently that significantly impact the organization. The Lead delegates assignments from vendor, audit, and compliance projects, ensuring completion within the appropriate time frame. They conduct high-level analysis of other team members' transactions before releasing them to payees or for next-level approval. This position ensures continuous improvement by applying various experiences to look beyond issues and uncover the underlying causes of problems, credits, and refunds. The Lead demonstrates a sense of ownership by providing solutions to critical issues and regularly engaging with peers and external partners as needed. They demonstrate expert-level knowledge of the Refund/Adjustment processes and utilize systems/applications proficiently to resolve credit balances and process refunds appropriately. This role approaches high-level problems from different angles, identifies ways to mitigate risks, and develops concrete solutions with little or no precedent. The Lead drives 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. They recommend and implement process enhancements, monitor account follow-up, and ensure timely processing of credits and refunds while acting as a resource to all team members and external partners. This role collaborates with leadership, level II's, operations, and the Revenue Cycle Process Designer as needed to update or draft workflow updates. The Lead 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 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

• 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.

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
• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance
• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED