Job description

Summary

Altus Biologics is dedicated to Treating Each Patient Like Family through its management of the administrative aspects of our physician’s biologic therapy practices. Our clinical professionals and administration staff are experienced and achieve desired results. We have a team environment that is filled with motivated, hard-working, and joyful employees ready to help our physicians and patients. Altus fosters opportunities for development and would like to provide you a real chance to make a difference.

Duties and Responsibilities

• Refund Specialist will receive reports of refund review from Vendors and other resources and be responsible for taking action to complete identified refunds to patients and insurance
• Refund Specialist will run AR Aging reports specific to credit balances to identify overpaid accounts across all clients
• Follow up on overpaid accounts to identify if a refund should be issued to insurance or patient
• Analyze claim submissions and payment postings along with supporting EOBs/ERAs and other account information to determine if credit balances are valid and have sufficient supporting documentation to warrant a refund or recoupment request. This includes utilizing billing packets, payer policies, payer sites, account managers, client practice management systems, and any resources available to investigate and resolve refund requests and overpayment reviews
• Investigate patient balances to determine if appropriate quote of benefits is being supplied by account manager and notify management of issues related to mis-quotes that result in overpayments by patient
• Notify management of any identified payer trends related to overpayments or refund requests
• Document all work performed in the patient account in the billing practice management system
• Perform adjustments to account balances as required with management approval
• Call payers to dispute erroneous refund requests or notify payer of intent to appeal refund request to put the refund process in suspense with payer while appeal is being reviewed
• Submit appeals and perform claim reconsiderations as required when erroneous refund requests are received from insurance payers
• File written appeals with payers as appropriate within the payer filing deadlines so as to avoid an additional denial of untimely filing that may result in payer taking recoupment actions for failure to respond to refund request in a timely manner
• Complete all required refund paperwork with supporting documentation and for submitting refund packets to client services team to distribute on a per client basis
• Track refunds sent for completion in billing system to ensure that client services team has sent back proof of refunds and that appropriate debits have been applied by payment posters or other assigned personnel
• Refund Specialist will exercise good judgment in determining how to prioritize their workload and tasks by payer filing deadlines
• Additional duties as assigned by management

Qualifications

Required:

• High School Diploma or equivalent
• 2-3 years of healthcare payment posting experience

Desired:

• 1-2 years healthcare Accounts Receivable experience

Altus Biologics provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting and hiring.

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