<h3>Job Description</h3>
Job Description
REFUND SPECIALIST
REMOTE
Company Overview: AMSURG is an independent leader in ambulatory surgery center services, operating a network of more than 250 surgery centers nationwide. In partnership with physicians and health systems, the organization delivers high-quality care for patients across a diverse spectrum of medical specialties, including gastroenterology, ophthalmology and orthopedics. To learn more about AMSURG, visit www..
POSITION SUMMARY:
Position is responsible for processing patient and payer overpayments. The duties include but are not limited to the follow-up of accounts, verifying and updating information and assisting in completing special projects during month-end and year-end financial reporting process.
Work Schedule: REMOTE
ESSENTIAL RESPONSIBILITIES:
<ul>
<li>Follow-up on credit balances listed on monthly AR and Payer Follow-up reports.</li>
<li>Review and update patient demographics and payer information as necessary for completion of claims payment.</li>
<li>Review credit balances for refund request form completion and notates the accounts.</li>
<li>Responsible for transferring balances and printing documents for refund.</li>
<li>Document all communications regarding account balance follow-up in the patient account.</li>
<li>Attend in-services, seminars and webinars for additional education and performance improvement.</li>
<li>Regular and reliable attendance required.</li>
<li>Making outbound calls and receiving inbound calls from patients</li>
</ul>
QUALIFICATIONS: 
To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. The requirements listed below are representative of the knowledge, skills and/or abilities required.
Education/Experience:
<ul>
<li>High school education or GED with minimum of two (2) years’ experience in accounts receivables collections and refunds preferred.</li>
</ul>
Mathematical Skills:
<ul>
<li>Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions, decimals and percentages.</li>
</ul>
Language Skills:
<ul>
<li>Ability to understand, read, write and speak English. Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures or governmental regulations. Ability to successfully write business correspondence. Ability to effectively present information, respond to questions and professionally interact with managers, employees, clients, vendors and the general public.</li>
</ul>
Reasoning Ability:
<ul>
<li>Ability to recognize and define problems, collect data, establish facts, draw valid conclusions and correct errors. Ability to understand and interpret basic financial data. Ability to interpret a variety of instructions in a variety of forms and deal with abstract and concrete variables.</li>
</ul>
Other Qualifications:
Must have excellent time management skills and be able to handle multiple, simultaneous tasks effectively and efficiently while maintaining a professional, courteous manner. Must be able to work well with others. Strong verbal and written communication skills required. Must be detail oriented and organized. High integrity, including maintenance of confidential information. Must be able to exercise good judgment and positively influence and lead others, including handling confrontations with poise and efficiency. Based on business need, the ability to work a flexible schedule, including some evenings and weekends as approved in advance.
Employment at AMSURG: Living Our Values Every Day At AMSURG, our values define who we are and how we serve our patients, partners, and each other. As a national leader in ambulatory surgery, we are committed to a culture of excellence, integrity, teamwork and caring deeply. Our values guide every decision, ensuring we continue to elevate healthcare and provide the highest quality care. These guiding principles are the foundation of our culture and a guide to how we collaborate, innovate, and make a difference every day.
<ul>
<li>Care Deeply for those around us.</li>
<li>Cultivate Integrity to build trust.</li>
<li>Champion Excellence for continuous improvement</li>
<li>Celebrate Teamwork every step to the way.</li>
</ul>
Benefits:
To ensure we retain and invest in great people, AMSURG provides its employees with the benefits, recognition, training, and opportunities needed for professional growth. Our wide range of health and welfare benefits allow you to choose the right coverage for you and your family. AMSURG offers a variety of health and welfare benefit options to help protect your health and promote your wellbeing. Benefits offered include but are not limited to: Paid Time Off, Medical, Dental, Vision, Life, Disability, Healthcare FSA, Dependent Care FSA, Limited Healthcare FSA, FSAs for Transportation and Parking &amp; HSAs, and a matching 401(K) Plan.
Paid Time Off:
AMSURG offers paid time off, 9 observed holidays, and paid family leave. You accrue Paid Time Off (PTO) each pay period and depending on your position and can earn a minimum of 20 days and up to 25 days per calendar year.
EOE Statement:
AMSURG is an Equal Opportunity Employer (EOE). Qualified applicants are considered for employment without regard to age (40 or older), race, color, religion, gender, sex, national origin, pregnancy, sexual orientation, disability, genetic information or any other status protected under applicable federal, state, or local laws. We strive to also provide a disability inclusive application and interview process. If you are a candidate with a disability and require reasonable accommodation in order to submit an application, please contact us at: careers@. Please include your full name, the role you’re applying for and the accommodation necessary to assist you with the recruiting process. 
#LI-CH1
#LI-REMOTE

Refund Specialist

<h3>Job Description</h3>
Job DescriptionAt Zotec Partners, our People make it happen.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Transforming the healthcare industry isn’t easy. But when you build a team like the one we have, that goal can become a reality. Our accomplishments can’t happen without our extraordinary people – the men and women across the country who make up our diverse Zotec family and help make this company a best place to work. Over 25 years ago, we started Zotec with a clear vision, to partner with physicians to simplify the business of healthcare. Today we are more than 900 employees strong and we continue to use our incredible talent and energy to bring that vision to life.&nbsp; We are a team of Innovators, Collaborators and Doers. As a Refund Specialist, you will be responsible for timely resolution of credit balances by analyzing patient accounts for needed refund or adjustment to patient or insurance carriers. What you’ll do:
<ul>
<li>Review and coordinate refunds for patients and/or insurance carriers</li>
<li>Extensive insurance follow-up with a wide variety of payers, including Medicare, Medicaid, Blue Cross and major commercial carriers</li>
<li>Utilize your high-level understanding of medical accounts receivable to identify and work with insurance carriers</li>
<li>Other duties as assigned</li>
</ul>
What you’ll bring to Zotec:
<ul>
<li>High School diploma or equivalent required</li>
<li>1-3 years of experience in AR/Refunds preferred</li>
<li>Knowledge of medical terminology and physician billing processing</li>
<li>Must be fluent in reading EOBs</li>
<li>Strong organizational and interpersonal communication skills, both verbal and written</li>
<li>Excellent analytical and problem-solving skills as well as the ability to multi-task and be detail orientated</li>
<li>Experience in reviewing and coordinating refunds for patients and/or insurance carriers is helpful</li>
<li>Ability to follow-through, assume responsibility and use good judgement</li>
<li>Ability to prioritize workload and meet specific goals and objectives</li>
<li>Ability to maintain professionalism in stressful situations</li>
<li>Ability to work as part of a team</li>
</ul>
At Zotec, you will enjoy a network of highly experienced professionals in an environment where you can operate with autonomy yet have the resources and backing of other professionals in a similar role. Entrepreneurial and enterprising is the spirit of our team. If you are an original thinker and opportunity seeker, we'd like to talk to you! Learn more about our organization, by visiting us at <a href="http://www.zotecpartners.com" target="_blank">www.zotecpartners.com</a> E-Verify and Equal Opportunity Employer
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6r4hrVECdq

<h3>Job Description</h3>
Job Description
Overview
Amerita is a leading provider of Specialty Infusion services focused on providing complex pharmaceutical products and clinical services to patients outside of the hospital. As one of the most respected Specialty Infusion providers in America, we service thousands of patients nationwide through our growing network of branches and healthcare professionals. The Refund/Dispute Specialist is responsible for processing incoming payer refund requests by researching to determine whether the refund is appropriate or a payer dispute is warranted in accordance with applicable state/federal regulations and company policies. The Refund/Dispute Specialist works closely with other staff to identify, resolve, and share information regarding payer trends and provider updates. The employee must have the ability to prioritize, problem solve, and multitask. 
This is a Remote opportunity. Applicants can reside anywhere within the Continental USA.
Schedule: Monday-Friday, 7:00AM to 3:30PM Mountain Time
We Offer:
• Medical, Dental &amp; Vision Benefits plus, HSA &amp; FSA Savings Accounts • Supplemental Coverage – Accident, Critical Illness and Hospital Indemnity Insurance • 401(k) Retirement Plan with Employer Match • Company paid Life and AD&amp;D Insurance, Short-Term and Long-Term Disability • Employee Discounts • Tuition Reimbursement • Paid Time Off &amp; Holidays 
 
Responsibilities
<ul>
<li>Reverses or completes necessary adjustments within approved range. Ensures daily accomplishments by working towards individual and company goals for cash collections, credit balances, medical records, correspondence, appeals/disputes, accounts receivable over 90 days, and other departmental goals</li>
<li>Understands and adheres to all applicable state/federal regulations and company policies</li>
<li>Understands insurance contracts in terms of medical policies, payments, patient financial responsibility, credit balances, and refunds</li>
<li>Verifies dispensed medication, supplies, and professional services are billed in accordance to the payer contract. Validates accuracy of reimbursement and the appropriate deductible and cost share amounts billed to the patient per the payer remittance advice.</li>
<li>Reviews remittance advices, payments, adjustments, insurance contracts/fee schedules, insurance eligibility and verification, assignment of benefits, payer medical policies and FDA dosing guidelines to determine if a refund or dispute is needed. Completes payer/patient refunds as needed and validates receipt of previously submitted refunds/disputes.</li>
<li>Creates payer dispute letters utilizing Amerita’s standard dispute templates and gathers all supporting documentation to substantiate the dispute. Submits disputes to payers utilizing the most efficient resources, giving priority to electronic solutions such as payer portals. Scans and attaches disputes to patient’s electronic medical record in CPR+.</li>
<li>Works closely with intake, patients, and payers to settle coordination of benefit issues. Communicates new insurance information to intake for insurance verification and authorization needs. Submits credit rebill requests as needed to the billing department or coordinates patient-initiated billing efforts to insurance companies. </li>
<li>Initiates and coordinates move and cash research requests with the cash applications department. </li>
<li>Utilizes approved credit categorization criteria and note templates to ensure accurate documentation in CPR+</li>
<li>Works within established departmental goals and performance/productivity metrics</li>
<li>Identifies and communicates issues and trends to management</li>
</ul>
 
Qualifications
<ul>
<li>High School diploma/GED or equivalent required; some college a plus</li>
<li>A minimum of one to two (1-2) years of experience in revenue cycle management with a working knowledge of Managed Care, Commercial, Government, Medicare, and Medicaid reimbursement</li>
<li>Working knowledge of automated billing systems; experience with CPR+ and Waystar a plus</li>
<li>Working knowledge and application of metric measurements, basic accounting practices, ICD 9/10, CPT, HCPCS coding, and medical terminology</li>
<li>Solid Microsoft Office skills with the ability to type 40+ WPM</li>
<li>Strong verbal and written communication skills with the ability to independently obtain and interpret information</li>
<li>Strong attention to detail and ability to be flexible and adapt to workflow volumes </li>
<li>Knowledge of federal and state regulations as it pertains to revenue cycle management a plus Flexible schedule with the ability to work evenings, weekends, and holidays as needed</li>
</ul>

Refund Dispute Specialist

<h3>Job Description</h3>
Job Description
Must-have:
<ul>
<li>
At least 1 year of experience in hospital billing.&nbsp;
</li>
<li>
Previous billing/accounts receivable systems experience.
</li>
<li>Strong communication skills.&nbsp;</li>
</ul>
Job Description:&nbsp;Insight Global is seeking 1 Insurance Refund Specialist to support the Patient Financials Team for a large healthcare system based out of Annapolis, MD. This person is required to be on-site three days a week and is required to perform the following duties:&nbsp;
<ul>
<li>
Credit Work Queue Management
<ul>
<li>Work daily on patient credit queues, processing an average of 30 accounts per day, with potential spikes up to 100+ due to large payments.</li>
<li>Ensure timely resolution of credit balances and maintain queue hygiene.</li>
</ul>
</li>
<li>
Insurance Credit Processing
<ul>
<li>Handle insurance overpayment requests received via email, mail, or fax.</li>
<li>Prioritize daily processing of these requests and coordinate with insurance companies directly via email, fax, and phone.</li>
</ul>
</li>
<li>
Vendor &amp; Payor Coordination
<ul>
<li>Collaborate with contracted vendors (e.g., Aetna, Cigna, BCBS) and non-contracted third-party payors.</li>
<li>Primary vendor contact includes Cotivity for insurance credit handling.</li>
</ul>
</li>
<li>
Refund &amp; Payment Posting
<ul>
<li>Process electronic and paper refund checks, document accounts, and complete required paperwork.</li>
<li>Post credit card payments from companies and lockbox sources, ensuring lockbox rules are followed (e.g., no insurance or credit card payments posted from lockbox).</li>
</ul>
</li>
<li>
Banking Correspondence
<ul>
<li>Print and sort daily banking correspondence from patient and insurance lockboxes.</li>
<li>Distribute documents to appropriate internal teams for further action.</li>
</ul>
</li>
<li>
Team Collaboration
<ul>
<li>Work closely with a team of six, supporting shared goals and assisting peers as needed.</li>
</ul>
</li>
</ul>
Company DescriptionAt Insight Global, we’re more than just a staffing agency — we’re a people-first solutions firm that believes in the power of connection. With a nationwide presence and a reputation built on trust, integrity, and results, we specialize in placing top-tier talent across healthcare, IT, education, engineering, and professional services. 
<h3>Company Description</h3>
At Insight Global, we’re more than just a staffing agency — we’re a people-first solutions firm that believes in the power of connection. With a nationwide presence and a reputation built on trust, integrity, and results, we specialize in placing top-tier talent across healthcare, IT, education, engineering, and professional services.

Insurance Refund Specialist

<h3>Job Description</h3>
Job DescriptionDescription:
 
Join our team at Cobalt Benefits Group and start an exciting new career in employee benefits solutions. As a Claims Refund Specialist, you’ll play an important role in helping us offer customized, self-funded insurance options to our clients and members.
 
Reporting to the Claims Manager and Assistant Claims Manager, the Refund Specialist is responsible for various administrative tasks related to services and claims for our health plans. The ideal candidate is detail-oriented, with exceptional communication skills, and a background in healthcare/insurance processing.
 
Key Responsibilities:
<ul>
<li>Audit, review, and adjust medical, dental, and flexible spending accounts and Health Reimbursement Account claims.</li>
<li>Review, apply and create refund letters for all lines of business to members and providers.</li>
<li>Reprocess payments when necessary.</li>
<li>Communicate with members, providers, employer group contacts, and other inquirers pertaining to specific refund questions.</li>
<li>Review plan documents for various groups to research and resolve claim processing questions and issues.</li>
<li>Act with urgency to respond to inquiries regarding refund request status-including research and resolution regarding outstanding request.</li>
<li>Perform other related duties, as assigned.</li>
</ul>
Requirements:
<ul>
<li>6 months’ experience in healthcare or insurance industry with respect to operations support, including provider maintenance, billing, coding, or customer support.</li>
<li>Experience in health care billing or a background with a health insurance carrier or Third-Party Administrator strongly desired.</li>
<li>Solid time-management skills, with the ability to prioritize multiple tasks, while working with a sense of urgency.</li>
<li>Strong interpersonal skills with excellent verbal and written communication skills.</li>
<li>Basic keyboard and Windows based computer skills required.</li>
<li>Familiarity with Microsoft Excel.</li>
<li>Eager to learn the TPA industry and new concepts and processes.</li>
</ul>
Work Environment &amp; Physical Demands:
<ul>
<li>Hybrid/ remote work availability may be offered based on meeting key performance metrics.</li>
<li>Prolonged periods of sitting may be required.</li>
<li>Regular use of a computer, keyboard, and mouse is necessary; reasonable accommodations will be provided upon request.</li>
<li>Employees should ensure an ergonomically appropriate desk and chair setup.</li>
<li>Comfort with being on camera for virtual meetings (e.g., Microsoft Teams)</li>
</ul>
Benefits:
 
After successfully completing a waiting period, eligible Full-time employees have access to our comprehensive benefits package, including:
<ul>
<li>Fantastic medical, dental, and vision insurance*</li>
<li>Twice annual employer HSA contributions, covering 50% of the HDHP plan’s annual deductible!</li>
<li>Company provided Basic Life and AD&amp;D</li>
<li>Company paid Short-Term and Long-Term Disability**</li>
<li>Flexible Spending Accounts*</li>
<li>401(k) Retirement Plan with up to a 6% employer-match** WOW! (100% fully vested after 3 years)</li>
<li>10+ paid holidays</li>
<li>Generous paid vacation and sick time</li>
<li>Annual Volunteer Paid Day</li>
<li>Annual Tuition Reimbursement</li>
<li>Annual Health and Wellness Reimbursement</li>
<li>Lots of fun company events</li>
</ul>
Who We are:
 
As a trusted third-party administrator (TPA) specializing in self-funded benefit plans, Cobalt Benefits Group (CBG) is committed to helping employers find high-quality coverage at a cost they can afford. We administer self-funded insurance benefits through our three companies: EBPA, Blue Benefit Administrators of Massachusetts, and CBA Blue.
 
With over 30 years of experience and a dedicated team of more than 200 employees, we work collaboratively to build customized self-funded health plans, manage claim payments and disputes, and administer other specialized programs such as FSAs, HSAs, COBRA, and retiree billing. Join us as we match employers across our region with the right solutions for their employee benefit needs. To learn more about working at CBG, visit <a href="https://www.cobaltbenefitsgroup.com/careers/" target="_blank">https://www.cobaltbenefitsgroup.com/careers/</a>.
 
Benefit Waiting Period Notes:
 
*60 day waiting period **90 day waiting period

Claims Refund Specialist

<h3>Job Description</h3>
Job Description Description:
 
Join our team at Cobalt Benefits Group and start an exciting new career in employee benefits solutions. As a Claims Refund Specialist, you'll play an important role in helping us offer customized, self-funded insurance options to our clients and members.
 
Reporting to the Claims Manager and Assistant Claims Manager, the Claims Refund Specialist is responsible for various administrative tasks related to services and claims for our health plans. The ideal candidate is detail-oriented, with exceptional communication skills, and a background in healthcare/insurance processing.
Key Responsibilities:
<ul>
<li>Audit, review, and adjust medical, dental, and flexible spending accounts and Health Reimbursement Account claims.</li>
<li>Review, apply and create refund letters for all lines of business to members and providers.</li>
<li>Reprocess payments when necessary.</li>
<li>Communicate with members, providers, employer group contacts, and other inquirers pertaining to specific refund questions.</li>
<li>Review plan documents for various groups to research and resolve claim processing questions and issues.</li>
<li>Act with urgency to respond to inquiries regarding refund request status-including research and resolution regarding outstanding request.</li>
<li>Perform other related duties, as assigned.</li>
</ul>
Requirements:
<ul>
<li>6 months' experience in healthcare or insurance industry with respect to operations support, including provider maintenance, billing, coding, or customer support.</li>
<li>Experience in health care billing or a background with a health insurance carrier or Third-Party Administrator strongly desired.</li>
<li>Solid time-management skills, with the ability to prioritize multiple tasks, while working with a sense of urgency.</li>
<li>Strong interpersonal skills with excellent verbal and written communication skills.</li>
<li>Basic keyboard and Windows based computer skills required.</li>
<li>Familiarity with Microsoft Excel.</li>
<li>Eager to learn the TPA industry and new concepts and processes.</li>
</ul>
Work Environment &amp; Physical Demands:
<ul>
<li>Hybrid/ remote work availability may be offered based on meeting key performance metrics.</li>
<li>Prolonged periods of sitting may be required.</li>
<li>Regular use of a computer, keyboard, and mouse is necessary; reasonable accommodations will be provided upon request.</li>
<li>Employees should ensure an ergonomically appropriate desk and chair setup.</li>
<li>Comfort with being on camera for virtual meetings (e.g., Microsoft Teams)</li>
</ul>
Benefits:
 
After successfully completing a waiting period, eligible Full-time employees have access to our comprehensive benefits package, including:
<ul>
<li>Fantastic medical, dental, and vision insurance*</li>
<li>Twice annual employer HSA contributions, covering 50% of the HDHP plan's annual deductible!</li>
<li>Company provided Basic Life and AD&amp;D</li>
<li>Company paid Short-Term and Long-Term Disability**</li>
<li>Flexible Spending Accounts*</li>
<li>401(k) Retirement Plan with up to a 6% employer-match** WOW! (100% fully vested after 3 years)</li>
<li>10+ paid holidays</li>
<li>Generous paid vacation and sick time</li>
<li>Annual Volunteer Paid Day</li>
<li>Annual Tuition Reimbursement</li>
<li>Annual Health and Wellness Reimbursement</li>
<li>Lots of fun company events</li>
</ul>
Who We are:
 
As a trusted third-party administrator (TPA) specializing in self-funded benefit plans, Cobalt Benefits Group (CBG) is committed to helping employers find high-quality coverage at a cost they can afford. We administer self-funded insurance benefits through our three companies: EBPA, Blue Benefit Administrators of Massachusetts, and CBA Blue.
 
With over 30 years of experience and a dedicated team of more than 200 employees, we work collaboratively to build customized self-funded health plans, manage claim payments and disputes, and administer other specialized programs such as FSAs, HSAs, COBRA, and retiree billing. Join us as we match employers across our region with the right solutions for their employee benefit needs. To learn more about working at CBG, visit <a href="https://www.cobaltbenefitsgroup.com/careers/" target="_blank">https://www.cobaltbenefitsgroup.com/careers/</a>.
 
Benefit Waiting Period Notes:
 
*60 day waiting period **90 day waiting period
 Equal Opportunity Employer, including disability/protected veterans 
PI277175634

<h3>Job Description</h3>
Job Description
 
 Why do Payment Integrity &amp; Refund Specialists want to work here? The reason people love working for KabaFusion is because of the impact we have on our patients. Here, it doesn’t matter what your role is, you will be part of a team that works collaboratively to change lives. You will go home knowing you’ve made a difference and improved someone’s life.
About us: 
What started as a single pharmacy in 2010 has grown into KabaFusion becoming the largest privately held home infusion company in the country. We have a national network of pharmacies and nursing offices strategically placed to service 40+ states. Couple that with over 30 years of combined experience and it’s no wonder why KabaFusion is the industry leader in home infusion.
About the role:
As a Payment Integrity &amp; Refund Specialist with KabaFusion, you will review claims for accuracy. This will include familiarizing yourself with the various payors we work with; understanding their fee schedules and contract requirements, making claims adjustments when necessary. 
Essential Duties &amp; Responsibilities:
<ul>
<li>Improve the reimbursement process by identifying claims errors and making adjustments as needed prior to submittal</li>
<li>Provide feedback and process improvement recommendations to upper management</li>
<li>Maintain continuous, accurate, and complete documentation</li>
</ul>
As a Payment Integrity &amp; Refund Specialist, you bring:
<ul>
<li>Bachelor’s degree in business administration, Healthcare Administration, or other related fields (preferred)</li>
<li>1+ year of revenue cycle experience in a healthcare setting</li>
<li>1+ year of quality assurance, auditing, compliance, and/or process improvement in a healthcare setting</li>
<li>Intermediate / Advanced Excel skills</li>
<li>Good communication and interpersonal skills</li>
</ul>
Our Benefits:
<ul>
<li>Benefits start on your 1st day of employment.</li>
<li>401k w 4% match – no waiting or vesting period</li>
<li>PTO / Floating Holidays / Paid Holidays</li>
<li>Company paid life insurance and short-term disability</li>
<li>Employee Assistance programs to help with mental health / wellness</li>
<li>Learning &amp; Development Programs</li>
<li>Perks… includes discounts on travel, cell phone, clothing and more…</li>
<li>Generous employee referral program</li>
</ul>
To learn more about KabaFusion, please visit our careers page:<a href="https://www.kabafusion.com/careers/" target="_blank">https://www.kabafusion.com/careers/</a>
KabaFusion is a mission driven company with a focus on innovation and patient care so, as a Pharmacy Technician, if that sounds like something you want to be a part of, then look no further.

Payment Integrity & Refund Specialist

<h3>Job Description</h3>
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
\n
The Denials and Refund Management Specialist will be focused on refund requests – you will be reading, interpreting, and analyzing commercial contracts. Once you are able to validate whether or not the request is valid, you will submit the appeal to contest the refund. Once the appeal is granted, you will request a refund from the commercial payors due to the claim having been declined instead of accepted. People who have a very extensive background in interpreting and analyzing commercial contracts will do well in this position.
\n
This position is full-time, Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 3:30pm PST. It may be necessary, given the business need, to work occasional overtime. Employees are required to work 1 day onsite and 4 days from home.
\n
We offer 2 weeks of paid training. The hours during training will be 8:00am - 4:30pm PST, Monday - Friday.
\n
If you are within commutable distance to the office at 5003 Commercial Circle, Concord, CA 94520, you will have the flexibility to work from home and the office in this hybrid role* as you take on some tough challenges.
\n\n
Primary Responsibilities:
\n
<ul>\n
<li>Collect and resolve denied payments from insurance companies by contacting assigned payers</li>
\n
<li>Execute the denial appeals process, which includes receiving, assessing, documenting, tracking, responding to, and/or resolving appeals with third-party payers in a timely manner</li>
\n
<li>Research and resolve payer rejected/denied claims and analyze accounts for insurance payment accuracy/completeness and for payer claim processing accuracy per contract. Work with clinical staff as needed to follow-up and appeal denials</li>
\n
<li>Maintain data on the types of claims denied and root causes of denials, and collaborate with team members to make recommendations for improvement and issue resolution</li>
\n
<li>Prepare, maintain, assist with, and submit reports as required</li>
\n
<li>Track and trend recovery efforts by utilizing various departmental tools. Appropriately report on-going problems specific to, health system departments, and/or contracts</li>
\n
<li>Provide feedback and process improvement ideas to management regarding facility, Patient Access, Case Management, HIM, Billing and/or payer issues identified when reviewing accounts for appeal</li>
\n
<li>Draft professional appeal letters in accordance with methodology in departmental policy and procedure including using correct grammar and spelling</li>
\n
<li>Identify contract issues related to denials and communicate those issues to Director of Revenue Integrity</li>
\n
<li>Provide on-going feedback to clinical staff about denial reasons, appeals and their outcomes, and managed care contractual requirements</li>
\n
<li>Transmit required documentation to Government and third-party payers for the purpose of resolving payments.</li>
\n
<li>Ensure all payer contact is fully documented in the appropriate software application</li>
\n
<li>Ensure claims are crossed over to secondary insurances, reporting any delay in unbilled secondary claims to the unit supervisor</li>
\n
<li>Consistently meet the current productivity standards in addressing and resolving denied accounts</li>
\n
<li>Consistently meet the current quality standards in taking appropriate actions to identify and track root causes, successfully appeal denied accounts, and trend issues</li>
\n
<li>Provide individual contribution to the overall team effort of achieving the department AR goal</li>
\n
<li>Identify opportunities for system and process improvement and submit to management</li>
\n
<li>Demonstrate proficient use of systems and execution of processes in all areas of responsibilities</li>
\n
<li>Demonstrate knowledge of John Muir Health System HIPAA privacy standards and ensure compliance with system PHI privacy practices</li>
\n
<li>Follow the Health System’s general Policy and Procedures, the Department’s Policy and Procedures, and the Emergency Preparedness Procedures</li>
\n
<li>Become cross-trained and fill in for other staff as assigned</li>
\n
<li>Follow department guidelines for lunch, breaks, requesting time off, and shift assignments</li>
\n
<li>Operate office equipment and machinery and utilizes ergonomic workstations, equipment, and supplies</li>
\n
<li>Follow JCAHO and outside regulatory agencies’ mandated rules and procedures</li>
\n
<li>Utilize assigned menus and pathways in the hospital mainframe system. Report software application problems to the appropriate supervisor</li>
\n
<li>Utilize assigned menus and pathways in foreign software applications. &nbsp;Report software application problems to the appropriate supervisor</li>
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<li>Utilize assigned computer hardware. &nbsp;Report hardware problems to the appropriate supervisor</li>
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<li>Participate in the testing for assigned software applications, including verification of field integrity</li>
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<li>Perform other duties and responsibilities as assigned</li>
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<li>Maintain confidentiality in matters relating to patient/family</li>
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<li>Assure patient privacy and confidentiality as appropriate or required</li>
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<li>Ensure minors have a parent or guardian listed as guarantor as appropriate</li>
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<li>Maintain professional relationships and convey relevant information to other members of the healthcare team within the facility and any applicable referral agencies</li>
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<li>Initiate communication with peers about changes and procedures</li>
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<li>Relay information appropriately over telephone, email, and other communication devices</li>
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<li>Interact with internal customers including HIM, Revenue Integrity, Patient Access, and the SBO in a professional manner to achieve revenue cycle department AR goals and objectives</li>
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<li>Assist with special projects as assigned</li>
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<li>Work closely with other staff, co-workers, peers, and other members of the healthcare team to ensure a positive and effective work environment</li>
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<li>Report to appropriate personnel regarding assignments, projects, etc.</li>
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<li>Initiate problem solving and conflict resolution skills to foster effective work relationships with peers</li>
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<li>Report to work on time and as scheduled</li>
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<li>Attend staff meetings, in-services, and continuing education</li>
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<li>Assist in the development of indicators, thresholds, study methods, and data collection as assigned</li>
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<li>Respond to problems/opportunities to improve care/customer service</li>
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<li>Support involvement in system performance improvement initiatives</li>
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<li>Participate in and maintain competencies required for the position and specific unit/area(s) of assignment</li>
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You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
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<ul>\n
<li>High School Diploma / GED</li>
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<li>Must be 18 years of age OR older</li>
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<li>2+ years of experience with insurance follow-up and/or payment variance review</li>
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<li>2+ years EPIC experience</li>
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<li>2+ years hospital accounts billing follow up experience – not professional billing</li>
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<li>2+ years of experience analyzing commercial contracts including interpreting commercial language</li>
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<li>Ability to perform mathematical calculations</li>
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<li>Keyboard by touch</li>
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<li>Intermediate experience and knowledge Microsoft Office including ability to open, create, save, edit, and send Excel Spreadsheets, Word Documents, and Outlook emails and calendar invites</li>
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<li>Must be able to work in the office at least one day a week</li>
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<li>Ability to work full-time, Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7am – 3:30pm PST. It may be necessary, given the business need, to work occasional overtime</li>
\n</ul>
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Telecommuting Requirements:
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<ul>\n
<li>Reside within commutable distance to the office at 5003 Commercial Circle, Concord, CA 94520</li>
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<li>Ability to keep all company sensitive documents secure (if applicable)</li>
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<li>Required to have a dedicated work area established that is separated from other living areas and provides information privacy</li>
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<li>Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service</li>
\n</ul>
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Soft Skills:
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<ul>\n
<li>Strong organizational and project management skills</li>
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<li>Strong presentation skills</li>
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<li>Negotiation skills</li>
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<li>Leadership skills</li>
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<li>Detail-oriented, good organizational skills, and ability to be self-directed</li>
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<li>Ability to learn quickly and meet continuous timelines</li>
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<li>Strong time management skills, managing multiple priorities and a heavy workload in a high-stress atmosphere</li>
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<li>Flexibility to perform other tasks as needed in an active work environment with changing work needs</li>
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<li>High-level problem solving, analytical, and investigational skills</li>
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<li>Excellent internal/external customer service skills</li>
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<li>Excellent communication skills to include oral and written comprehension and expression</li>
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<li>Excellent communication skills when dealing with patients, families, public, co-workers, and professional offices</li>
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<li>Ability and willingness to exhibit behaviors consistent with principles of excellent service</li>
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<li>Ability and willingness to demonstrate and maintain competency as required for job title and the unit/area(s) of assignment</li>
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<li>Ability and willingness to exhibit behaviors consistent with standards of performance improvement and organizational values (e.g., efficiency &amp; financial responsibility, safety, partnership &amp; service, teamwork, compassion, integrity, and trust &amp; respect)</li>
\n</ul>
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*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
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Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 - $35.72 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
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At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
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UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
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UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
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#RPO #RED #RPOLinkedIn

Denials and Refund Management Specialist

<h3>Job Description</h3>
Job Description
ROLE OVERVIEW
The RCM Specialist II is an individual contributor role on the RCM team, responsible for AR follow-up, posting payments, processing refunds and credits, and auditing accounts accurately. This role supports the full revenue cycle, helping ensure timely resolution of outstanding balances, clean financial records, and a smooth experience for both practices and patients. An ideal candidate has a strong understanding of AR processes, account research, and payer guidelines. They are detail-oriented, analytical, and confident in navigating account-level discrepancies and improving key revenue cycle metrics. 
KEY RESPONSIBILITIES
<ul>
<li>Perform all assigned RCM activities in accordance with best practices and internal SOPs.</li>
<li>Perform AR follow-up to resolve unpaid or underpaid claims, denials, and aged balances through appropriate action (i.e. appeals, corrections, resubmissions, etc.)</li>
<li>Audit accounts to verify accurate claim submission, payment application, adjustments, and resolution of outstanding balances.</li>
<li>Review and resolve credit balances; process refunds to insurance and patients in compliance with regulations and internal policies.</li>
<li>Post all payments – insurance and patient – accurately and in a timely manner, including zero-dollar payments and remittance reconciliations (manual and electronic).</li>
<li>Apply adjustments and write-offs appropriately based on payer contracts and internal guidelines.</li>
<li>Work AR aging reports regularly to reduce days in AR and the percentage of AR over 90 days.</li>
<li>Maintain clear and thorough documentation of account activities, payer interactions, and refund processing steps.</li>
<li>Collaborate with internal teams (billing, front office) to ensure clean claims and quick resolution of issues.</li>
<li>Maintain compliance with HIPAA, payer guidelines, and internal policies.</li>
<li>Participate in team meetings to discuss performance metrics, workflow updates, and process improvements.</li>
<li>Support RCM management in understanding and self-identifying contributing factors to site-specific RCM KPIs, highlighting areas of concern and areas for improvement. KPIs include but may not be limited to:</li>
<li>Collection Rate: Monitor and report on the net collection rate, analyzing performance against targets. Collaborate with the team to identify opportunities for improvement. </li>
<li>Days in AR: Track and evaluate average days in AR to ensure appropriate advanced collection, payment application, efficient and accurate claim filing, and timely back-end billing and claim resolution. Investigate and address any delays or bottlenecks that may be causing extended days in AR. </li>
<li>% AR Over 90 Days: Review and analyze the percentage of AR over 90 days (insurance v. patient) to identify trends or issues requiring attention. Work with the team to reduce the percentage of aged receivables by implementing strategies to resolve outstanding claims and payments. </li>
<li>Identify trends in rejections, disputes, payment delays, and denials, and escalate issues for resolution. Always seek the root cause to avoid future issues</li>
<li>Maintain respect and professionalism in all interactions with internal stakeholders, patients, payers, third parties, and others</li>
</ul>
ESSENTIAL QUALIFICATIONS
<ul>
<li>Prior experience in Dental Office workflows, Revenue Cycle functions to include Scheduling, Registration, Insurance verification, fee schedules, claim submission, charging/coding requirements, insurance AR follow up and payment posting process</li>
<li>Must be knowledgeable of reimbursement/compliance process and procedures with all payors</li>
<li>Experience with practice management software systems, insurance portals, clearing houses, insurance guidelines, banking reconciliation software, proficient in intermediate PC skills (MS Office—strong excel skills). Strong computer literacy, Excellent Math and problem-solving skills. Data entry and 10-key by touch.</li>
<li>Strong interpersonal and organizational skills. Ability to work within a team setting and as an individual contributor. Excellent oral and written communication skills</li>
<li>Responsible for quality work, meeting deadlines, and adherence to Compliance and Revenue cycle standard operating procedures</li>
<li>Organized work habits, accuracy, and proven attention to detail with strong analytical skills</li>
<li>Responsible for quality work, meeting deadlines, and adherence to Compliance and Revenue cycle standard operating procedures </li>
</ul>
Certified Professional Coder (CPC) or Certified Revenue Cycle Professional (CRCP) credentials preferred

RCM Specialist II

<h3>Job Description</h3>
Job Description
SUMMARY:
The Revenue Cycle Operations Coordinator is cognizant of the philosophy, standards, objectives and policies of the Department and the Organization. The Coordinator shall have a thorough understanding of the FQHC/Article 28, Article 31, and Dental Rules and Regulations around the Medicaid and Medicare
RESPONSIBILITIES:
<ul>
<li>Compile and maintain records, statistics and reports as necessary.</li>
<li>Identify and resolve trends impacting ability to collect. Anticipate needs and improve existing workflows or develop new workflows that facilitate collections efforts.</li>
<li>Continuously reviews revenue cycle staff work for adherence to policies and procedures, to ensure the timely collections of insurance and patient due balances and that processing of denials are at optimal levels</li>
<li>Ensure daily/weekly/monthly medical claim submission. Resolve claim and remittance file issues as needed.</li>
<li>Ensure monthly patient statement billing and collections process</li>
<li>Troubleshoot billing and resolve problems with appropriate agencies, departments, and/or management</li>
<li>May assist with posting patient and insurance cash receipts, daily reconciliations, posting insurance denials, and work queue maintenance as needed to ensure all work is done timely to meet desired goals for designated area of accounts receivable.</li>
<li>Maintain patient/employee confidentiality in the management of protected information</li>
<li>Supervise and provide daily guidance to assigned staff to ensure appropriate and timely management of the receivables</li>
<li>Prepare evaluations, counsel staff on performance, and execute disciplinary actions up to and including termination for all assigned staff</li>
<li>Participate in the process of interviewing and hiring new staff</li>
<li>Coordinate new hire initial training, shadowing, and evaluation</li>
<li>Review and distribute correspondence and follow up as needed</li>
<li>Monitor current status of work queues for assigned staff including primary, secondary, and tertiary status and follow up</li>
<li>Identify and develop techniques to address issues creating unnecessary or excessive denials</li>
<li>Reviews denial reports to identify trends and resolve claim issues</li>
<li>Ensure all payments (ERA/Manual) are reconciled in a timely manner</li>
<li>Coordinate matters of lockbox and cash application by ensuring cash is applied, posting is balanced, reports run, and capitation and other miscellaneous payments are posted and reconciled in Epic against bank cash receipts.</li>
<li>Maintain assigned work queues</li>
<li>Ensure staff maintains monthly membership logs and reports data on shared drive spreadsheets</li>
<li>Communicate to Director of Revenue Cycle and IT department changes required to facilitate the collection process. This includes information relating to new product lines/plans as well as changes to existing product lines/plans and issues related to the EPIC system build.</li>
<li>Ensures Retro Adjudication Work Queues are worked weekly to ensure that all affected dates of service are billed and/or rebilled to appropriate responsible party (i.e. Medicaid, Insurance Carrier or Self Pay). This review process would include but would not be limited to the following: correcting Insurance Coverage start/end dates, rebilling previously posted charges to correct carrier or patient, adjusting charges as needed for capitation or reversal of capitation, notifying patient, and working with health center</li>
<li>Work with other management to create WQ &amp; Follow up standards.</li>
<li>Review and approve refund requests for assigned receivables and ensures process is followed. Coordinate processing with Finance Department.</li>
<li>Respond to incoming telephone or mail inquiries from patients, IFH centers/department, providers and payers regarding outstanding balances</li>
<li>Interact with other departments, insurance companies, medical professionals and patients’ on daily basis to resolve claims processing issues.</li>
<li>Recognize issues relating to provider credentialing and facilitates resolution.</li>
<li>May be responsible for Claim Printing/Reviewing of printed claim forms for accuracy to ensure claims are paid timely.</li>
<li>May be responsible for the submission of electronic claim and/or patient statement files depending on designated accounts receivable are (eMedNY, Change Healthcare, Ability {or current vendors})</li>
<li>Ensures smooth operations with clearinghouse vendor and facilitates payer requirements as needed for electronic claims processing and retrieval of electronic remittance advices.</li>
<li>May develop workflows, standards, and work queue requirements for billing staff to ensure claims are captured, billed timely, and paid as contracted</li>
<li>Generates standard A/R reports on a routine basis. Reports shall include an analysis of accounts receivable, denials, WQ issues related to system configuration, and needs assessment to improve cash flow.</li>
<li>Participate in new staff orientation programs to familiarize them with coding and billing procedures and policy updates as deemed necessary</li>
<li>May be asked to assist with special accounts receivable projects</li>
<li>May be responsible for Monthly EOC Survey</li>
</ul>
SKILLS:
<ul>
<li>Thorough understanding of FQHC, Article 28, Article 31, dental CMS, managed care, sliding fee, and commercial payer billing guidelines and regulations.</li>
<li>Understanding of the implications of facility/group agreements with health plans and the supplemental payment process</li>
<li>Ability to export, analyze, and format data which may include the development of graphs.</li>
<li>Ability to resolve staffing issues with tact and with professionalism.</li>
<li>Ability to maintain staff schedules and coordinate changes in responsibility as needed to ensure work is completed to meet deadlines.</li>
<li>Performance management experience including coaching and developing staff, preparing evaluations, and executing disciplinary actions</li>
<li>Understanding of medical Commercial, Medicaid, Medicare and Supplemental Payment Programs, Billing and Collections processes including electronic forms of data exchange (claims/ERA/Eligibility)</li>
<li>Knowledge of cash application procedures and aged accounts receivable reporting</li>
<li>Competent typing / keyboarding skills</li>
<li>Ability to handle multiple priorities and to deal calmly with individuals under stress</li>
<li>Basic computer skills, including Microsoft Word, Excel, Outlook and PowerPoint</li>
<li>Knowledge of CPT and ICD-10 Diagnosis coding</li>
<li>Proficiency in EPIC claims processing workflows preferred</li>
<li>Ability to run and interpret/analyze Crystal Reports and EPIC Workbench reports preferred</li>
</ul>
QUALIFICATIONS:
<ul>
<li>HS Diploma or GED required</li>
<li>Associates Degree preferred</li>
<li>Coding or Medical Billing Certification preferred</li>
<li>At least two years supervisory experience required (preferably in healthcare)</li>
<li>A minimum of 3 years of medical billing experience required</li>
<li>Proficiency in EPIC claims processing workflows preferred</li>
<li>Ability to run and interpret/analyze Crystal and EPIC Workbench reports preferred</li>
<li>Prior experience as an IFH Revenue Cycle Specialist III preferred</li>
</ul>

314 refund-specialist Jobs