Refund Specialist

Tranzeal is an industry leading global Business Transformation Service Provider offering specific consulting services as well as pre-packaged, industry specific solutions and services to companies around the world. Our Consulting Services are dedicated to helping our clients maximize their investments in IT and the overall effectiveness and efficiency of the business. Tranzeal s deep industry experience makes us the partner of choice for a growing number of Fortune 1000 companies, midsize enterprises and small businesses worldwide.

We are currently looking for 'Refund Specialist (with Overpayment Remediation and Refund exp)' to support one of our clients with the following skills:

Requirement:

Job Title: Refund Specialist (with Overpayment Remediation and Refund exp)

Location: Federal Way, WA / Remote

Duration: 6 months (Extendable Contract)

No. of positions: 9

Bill Rate: doe

Notes:

Top Skills: Overpayment Remediation, Refund experience, Multi-Task

Notes:

• Need to have overpayment remediation experience.
• Will have to go into all the claims and examine why they were overpaid by the insurance providers.
• Need to take action like refund the insurance provider, posting corrections.
• Need to be able to do 20-25 claims per day and accuracy has to be at least 90%.
• Need candidates who are Overpayment Remediation, Refund Specialists.
• Manager does not want to see someone coming from Banking or Dental billing experience.
• Bi-weekly performance checks will be done

Job Description:

Excited to grow your career?

Our Client is currently looking for a Refund Specialist for our Credits Team in our Revenue Operations Department. Individuals who excel in this role are highly ambitious, results driven, and willing to "think outside the box." This position requires a high level of attention to detail and the ability to work well as part of a fast paced team. The ideal candidate has a high level of multitasking abilities, strong mathematical and analytical skills, and is driven by resolving open balances with the goal to prevent future rework. In this position, you will analyze EOBs and/ or payor correspondence to reconcile system credit balances or potential overpayments, research and resolve problem accounts, and request adjustments. You will effectively identify trends and analyze root causes to drive work efficiently within the team. Hybrid and remote position available. All necessary equipment is provided.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Autonomously research, initiate follow-up and resolve all health care insurance claim accounts with existing credit balances (claim(s) paid more than expected by payer); actions included but not limited to initiating refund packets, retractions, and/or adjustments to claims
• Navigate through various payer systems and multiple internal systems to ensure timely and accurate resolution of claims
• Use critical thinking, root cause analysis, and problem solving skills to resolve issues on outstanding claim balances
• Uses strong organizational skills to effectively manage large amounts of detailed information
• Utilizes excellent written and oral communication skills to collaborate and maintain positive working relationships with peers, leaders, clinical personnel, and payer representatives to resolve credit balances.
• Contributes to implementation of process improvement initiatives aimed at improving credit department
• Ensures compliance by using established internal control procedures by examining records, reports, operating practices, and documentation
• Stay current on communications relating to healthcare reimbursement and regulatory changes
• Maintain confidentiality of all company and patient information in accordance with HIPAA regulations and client policies
• Understand and adhere to all policies, laws and regulations applicable to this role
• Consistent, regular, punctual attendance as scheduled is an essential responsibility of this position
• Participate in group settings and team work environment

Qualifications:

• High School Diploma or equivalent required
• Healthcare and medical claim overpayment remediation and refunding experience is required
• 2-4+ years experience with accounting, transactions, or medical billing/accounting systems required
• Knowledge or experience working with a variety of health care insurance payers is preferred
• Intermediate computer proficiency in Microsoft Office including Excel and Outlook- required

What We ll Provide:

• All necessary workstation equipment

At our client, we strive to be a community first and a company second. We want all teammates to experience client as "a place where I belong." Our goal is to embed Diversity & Belonging into everything we do in our Village, so that it becomes part of who we are. We are proud to be an equal opportunity workplace and an affirmative action employer. As such, individuals are recruited, hired, assigned and promoted without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, protected veteran status, or any other protected characteristic.

Schedule: Hourly Monday- Friday 8 hour shift, 40 hours per week (includes a clocked out 30 minute lunch every day) OT not available except upon Leadership approval for special circumstances/projects

First 120 days:

o PST: 8 am 4:30 pm

o MST: 8:30 am 5 pm (7:30 4 PM PST)

o CST: 8:30 am 5 pm (6:30 am 3 pm PST)

o EST: 9 am 5:30 pm (6 am -2:30 pm PST)

subject to change based on approval and meeting metric and performance expectations autonomously

Work Environment: Hybrid or Remote. Role requires a stationary, designated, and HIPPA Compliant workspace. Traveling with equipment is not permitted.