The Overpayment Specialist (OVPS-I) is assigned a group of credit balances and is responsible for accurately and efficiently resolving open claims. Additionally, this individual will review EOBs, contracts, and/or other supporting documentation to determine if payments need to be refunded or if balances can be adjusted by policies and procedures, including federal, state, and local standards, guidelines, and regulations.
Job Duties
Work credit balances for any financial class and insurance grouping including Self Pay, Commercial, Federal, and State insurance plans.
Work and track refunds via the 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 regularly and reviews for any issues.
Answer phone calls from patients, insurance companies, and collections agencies and manage refund requests according to processes and procedures.
Follow up on returned/voided checks.
Meet 30-day credit review expectations and 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 the business implications of decisions.
Perform other tasks, duties, and projects as requested by Management.
Requirements
Bachelor's degree with a focus in business or healthcare management - REQUIRED.
2 years' experience in accounts receivable or equivalent work experience with medical insurance providers - REQUIRED.
Dialysis or healthcare experience- REQUIRED.
Proficiency in Microsoft Office Suite- REQUIRED
Knowledge of Excel, PivotTable, and VLOOKUP- REQUIRED
"Pride Global offers eligible employee's comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, , legal support, auto ,home insurance, pet insurance, and employee discounts with preferred vendors. "