Refund Analyst Lead
US-CA-RANCHO CORDOVA
commonspirit_careers
Req #: 456001
Type: Day
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Overview: Dignity Health Medical Foundation, established in 1993, is a California nonprofit public benefit corporation with care centers throughout California. Dignity Health Medical Foundation is an affiliate of Dignity Health - one of the largest health systems in the nation - with hospitals and care centers in California, Arizona and Nevada. Today, Dignity Health Medical Foundation works hand-in-hand with physicians and providers throughout California to provide comprehensive health care services to the many communities we serve. As Dignity Health Medical Foundation continues to grow and establish new premier care centers, we provide increasing support and investment in the latest technologies, finest physicians and state-of-the-art medical facilities. We strive to create purposeful work settings where staff can provide great care, while advancing in knowledge and experience through challenging work assignments and stimulating relationships. Our staff is well-trained and highly skilled, qualities that are vital to maintaining excellence in care and service. Responsibilities: Under the supervision of the Refund Analyst, the Refund Analyst Lead is responsible for providing operational support and training to the Reimbursement/Refund Analyst team including rounding with staff, triaging issues and offering solutions. Additionally, they will assist supervisor with special projects including but not limited to providing timely and efficient follow-up with all payer types for all overpaid claims, consistent with the Mission and Philosophy of Dignity Health Medical Foundation. * Demonstrates a solid understanding of your role as a Refund Analyst Lead. * Payer Rules & Regulations * Understand Contract Language/Division of Financial Responsibility * Coordination of Benefit rules * Understand Offsets & Recoupments * Read & interpret invoice details * Patient registration in IDX * Rejection posting in IDX * Knowledge of medical records systems * Ability to navigate Insurance payer web sites * Read & interpret EOB & from various insurance carriers * FSC knowledge * Rules of FSC Flipping * Rules of Charge Corrections. * Understanding of claim edits * Acts as main point of contact for Refund Analyst staff and assists supervisor in resolving operational issues. Triages issues with staff and offers solutions. * Mentors and coaches Refund Analyst staff and provides constructive feedback * Takes initiative to find opportunities for process improvement within the department * Provides in-depth analysis of inventory to identify possible system issues, payer trends and areas for internal staff and Clinic Operations training development. * Has the ability to independently research and resolve complex and/or escalated issues with available resources and tools * Utilizes appropriate chain of command to assist in resolving complex issues after necessary research has been completed * Under the supervision of the Revenue Integrity Supervisor, responsible for assisting with the research and resolution of all outstanding credit balances, ensuring timely and accurate processing. * Timely review of electronic communication to stay informed of changes that affect your position. * Has the ability to manage multiple expectations, tasks and deadlines effectively. * Assists with audits as needed * Trains Refund Analyst Staff on workflows and processes as needed. * Proactively organizes and manages caseload to ensure timely follow through on credits. * Assists with special projects and tasks as assigned from Leadership Team. Qualifications: * High School Diploma or GED * Six years' experience working in healthcare revenue cycle and/or a professional medical billing office * One-year experience with IDX Practice Management System * Knowledge of physician billing regulations * Understanding of professional claims, billing procedures and reimbursement terms * Excellent interpersonal and organizational skills * Working knowledge of computers and demonstrated proficiency in using e-mail systems, Internet and office software applications * Knowledge of Google sheets * Strong MS Excel skills to interpret and analyze high volume of data Preferred Qualifications * Associates in Health Care Administration or related field * One year experience with Cerner EHR
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