Refund Specialist

UPMC•Pittsburgh, PA

11h

About The Position

The Refund Specialist is responsible for processing all credit balances, both insurance and self-pay, for refunds. This role involves reviewing credit balances for potential distribution to other debit balances, ensuring timely processing of validated Government payer refunds within payer guidelines, and maintaining department productivity standards. The specialist must ensure proper documentation is attached to all refund requests and perform duties in a manner that upholds UPMC's core values. Maintaining compliance with quality standards, prioritizing workflow based on balance and aging criteria, and processing incoming refund requests within 3 business days are key aspects of the role. The position also requires identifying and resolving credit accounts through refunds, adjustments, or payment transfers, adhering to the Fair Debt Extension Uniformity Act, and understanding applicable laws and regulations. Additionally, the specialist will identify credit balance issues impacting workflow, reconcile refund postings, and notify management of any trends creating credit balances.

Requirements

High School diploma or equivalent and 1 year of claims processing, billing or collections experience, OR High School diploma or equivalent and 3 years experience in a business office setting.
Knowledgeable in third party payer guidelines and reimbursement practices required.
Effective problem solving skills and ability to make independent decisions required.
Good oral and written communication skills.
Knowledge of medical terminology, third party payer guidelines and reimbursement practices.
Act 34

Nice To Haves

Bachelor's degree is preferred.
Experience or working knowledge of Microsoft Office products (Word, Outlook, Excel) preferred but not required.
Strong understanding of all patient accounting systems.

Responsibilities

Process all credit balances (insurance and self-pay) for refunds.
Review credit balances for possible distribution to other debit balances.
Ensure that all validated Government payer refunds are processed in a timely manner or within the payer guidelines.
Maintain department productivity guidelines.
Ensure that proper documentation is attached to all refund requests.
Perform duties and job responsibilities in a manner which promotes the core values of UPMC (Quality and Safety, Dignity and Respect, Caring and Listening, Excellence and Innovation, Responsibility and Integrity) in all consumer and UPMC interactions.
Maintain compliance with quality standards.
Prioritize work flow accordingly by balance and aging criteria.
Ensure that all incoming refund requests, either via CRM or email, are processed within 3 business days.
Identify and take action towards resolution of credit accounts through potential refunds, adjustments, payment transfers, etc.
Adhere to the Fair debt Extension Uniformity Act and understand the laws and regulations applicable to job functions.
Identify credit balance issues that may impact workflow.
Reconcile refund postings.
Notify management of any trends identified in workflow creating credit balances.