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Our CompanyAmerita OverviewThe 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. Above all, qualified candidates should possess exceptional internal and external customer service skills and actively promote Amerita's company culture. Schedule: 7am-3:30pm (MST) Monday- Friday High-quality, affordable benefits for all Full-time and Part-time Employees Medical, Dental & Vision Benefits plus, HSA & FSA Savings Accounts Supplemental Coverage – Accident, Critical Illness and Hospital Indemnity Insurance 401(k) Retirement Plan with Employer Match Company paid Life and AD&D Insurance, Short-Term and Long-Term Disability Employee Discounts Tuition Reimbursement Paid Time Off & Holidays Position will be posted for a minimum of 7 business days Responsibilities
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
Understands and adheres to all applicable state/federal regulations and company policies
Understands insurance contracts in terms of medical policies, payments, patient financial responsibility, credit balances, and refunds
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.
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.
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+.
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.
Initiates and coordinates move and cash research requests with the cash applications department.
Utilizes approved credit categorization criteria and note templates to ensure accurate documentation in CPR
Works within established departmental goals and performance/productivity metrics
Identifies and communicates issues and trends to management
Qualifications
High School diploma/GED or equivalent required; some college a plus
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
Working knowledge of automated billing systems; experience with CPR+ and Waystar a plus
Working knowledge and application of metric measurements, basic accounting practices, ICD 9/10, CPT, HCPCS coding, and medical terminology
Solid Microsoft Office skills with the ability to type 40+ WPM
Strong verbal and written communication skills with the ability to independently obtain and interpret information
Strong attention to detail and ability to be flexible and adapt to workflow volumes
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
About our Line of BusinessAmerita is a specialty infusion company focused on providing complex pharmaceutical products and clinical services to patients outside of the hospital. Committed to excellent service, our vision is to combine the administrative efficiencies of a large organization with the flexibility, responsiveness and entrepreneurial spirit of a local provider. For more information about Amerita, please visitwww.ameritaiv.com. Follow us onTwitter (https://twitter.com/AmeritaIV) and LinkedIn (https://www.linkedin.com/company/amerita-inc/) .Salary RangeUSD $18.00 - $20.00 / HourALERT: We are aware of a scam whereby imposters are posing as employees from our company. Beware of anyone requesting financial or personal information. We take pride in creating a best-in-class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card, driver’s license, bank information, or payment for work equipment, etc.) from you via text or email. If you are suspicious of a job posting or job-related email mentioning our company, please contact us at TalentAcquisition@brightspringhealth.com . Click here (https://www.brightspringhealth.com/careers/frequently-asked-questions/) for additional FAQ information. Job LocationsUS-CO-ENGLEWOODID 2024-146564 Line of Business Amerita Position Type Full-Time Pay Min USD $18.00/Hr. Pay Max USD $20.00/Hr.
