Overpayment Specialist
Company: Innovative Renal Care
Location: Beverly
Posted on: May 7, 2024
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Job Description:
Overpayment Specialist
The Overpayment Specialist (OVPS-I) is assigned a group of credit
balances and is responsible for accurately and efficiently
resolving the open claims. Additionally, this individual will
review EOB's, contracts and/or other supporting documentation to
determine if payments need to be refunded or if balances can be
adjusted in accordance with policies and procedures, including
federal, state and local standards, guidelines, and regulations.
Hybrid, on-site (Franklin, TN or Beverly, MA), or remote candidates
will be considered.
Essential Functions:
Work credit balances for any financial class and insurance grouping
including Self Pay, Commercial, Federal and State insurance
plans.
Work and track refunds via refund portal for the states that
require live checks.
Identify and process credit balances by state (as required) by
voiding in the applicable insurance portal, subject to
management pre-approval.
Appropriately identify, address, submit and process credit balance
adjustments.
Understand and interpret Explanation of Benefits
(EOB)/Remittances.
Responsible for reviewing and addressing incoming mail
correspondence.
Effectively communicate and collaborate with all levels of
staff/management and other internal departments.
Complete and maintain facility reports on a regular basis and
reviews for any issues.
Answer phone calls from patients, insurance companies and
collections agencies and manage refund requests according to
process and procedures.
Follow up on returned/voided checks.
Meet 30-day credit review expectation and clearly document all
claim follow up/activity within the billing system.
Maintain expected daily/weekly productivity by completing work
assignments and taking proper actions to resolve open credit
balances.
Provide coverage for other Overpayment Specialists when
necessary.
Gain knowledge of billing requirements by reviewing insurance
contracts and understanding billing language and rates. Maintain
knowledge of payer guidelines and procedures by staying up to date
with insurance updates.
Maintain strict confidentiality of patient personal
information.
Maintain HIPAA compliance.
Understand business implications of decisions.
Perform other tasks, duties and projects as requested by
Management.
Position Type, Expected Hours of Work & Travel:
This is a full-time, hybrid, remote, or on-site (Franklin, TN or
Beverly, MA) position. Office hours are Monday through Friday, 8:30
AM to 5:00 PM EST. Hours of work are based on regions supported.
Travel is not expected with this position.
Required Education and Experience:
- Bachelor's degree with a focus in business or healthcare
management preferred. Equivalent combination of education and
experience will be considered.
- 0-2 years of experience in accounts receivable, or equivalent
work experience with medical insurance providers.
- Experience in dialysis and/or healthcare is preferred.
- Excellent customer service skills, ability to actively contribute
as a team player and superior attention to detail required.
- Ability to work in a fast-paced environment while maintaining
high standards of accuracy required.
- Flexibility and ability to prioritize while alternating between
tasks.
- Adaptability and willingness to consistently learn new
skills.
- Proficiency in Microsoft Office Suite required.
- Knowledge of Excel, PivotTable and VLOOKUP required.
Equal Opportunity Employer:
American Renal Associates LLC is an equal opportunity employer and
a drug free workplace. All qualified We applicants will receive
consideration for employment without regards to race, color,
religion, sex, sexual orientation, gender identity, national
origin, citizenship, disability, or protected veteran status.
#LI-CR1
Equal Opportunity Employer/Protected Veterans/Individuals with
Disabilities
The contractor will not discharge or in any other manner
discriminate against employees or applicants because they have
inquired about, discussed, or disclosed their own pay or the pay of
another employee or applicant. However, employees who have access
to the compensation information of other employees or applicants as
a part of their essential job functions cannot disclose the pay of
other employees or applicants to individuals who do not otherwise
have access to compensation information, unless the disclosure is
(a) in response to a formal complaint or charge, (b) in furtherance
of an investigation, proceeding, hearing, or action, including an
investigation conducted by the employer, or (c) consistent with the
contractor's legal duty to furnish information. 41 CFR
60-1.35(c)
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Keywords: Innovative Renal Care, Cranston , Overpayment Specialist, Other , Beverly, Rhode Island
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