WE ARE HIRING!
Location:250 E Liberty Street Louisville, KY 40202 

About UofL Health 
UofL Health is a fully integrated regional academic health system with nine hospitals, four medical centers, Brown Cancer Center, Eye Institute, more than 250 physician practice locations, and more than 1,000 providers in Louisville and the surrounding counties, including southern Indiana. Additional access to UofL Health is provided through a partnership with Carroll County Memorial Hospital. 

Affiliated with the University of Louisville School of Medicine, UofL Health is committed to providing patients with access to the most advanced care available. This includes clinical trials, collaboration on research and the development of new technologies to both save and improve lives. With more than 14,000 team members – physicians, surgeons, nurses, pharmacists and other highly-skilled health care professionals, UofL Health is focused on one mission: to transform the health of communities we serve through compassionate, innovative, patient-centered care. For more information on UofL Health, go to www.UofLHealth.org.

Job Summary:

Serve as a lead specialist and role model for all Refund team members.  Responsible for receiving and analyzing accounts on credit balance report(s).  Review refund requests from insurance groups and patients and recommend for refund or process denial with supporting documentation as appropriate.  Approve small refund amounts based on approved threshold (e.g. less than $250).  Ensure insurance/patient balance is accurately stated after processing refund/adjustments.  Prepare and submit Medicare Credit Balance detail report and Certification page on a quarterly basis as required by the authority of sections 1815(a), 1833(e), 1886(a)(1)(C) and related provisions of the Social Security Act. 

• Collaborate with leaders to effectively prioritize, assign, & assist in the team workload.
• Identify opportunities and provide analysis and trend information with credit balances and refund issues across the UofL Health Facilities.
• Thoroughly research and understand process workflows to identify inefficiencies and recommend improvements within the refund team.
• Train refund staff and work with leadership and Education & Training Analyst to develop/maintain written processes and training aids.
• Review & approve small refund amounts for release as requested by team members per process authorized by Department Director (e.g. less than $250).
• Collaborate with other departments/teams on difficult or reoccurring issues hampering resolution of credit balances.
• Determine whether applied payments should be refunded by researching the payment, contractual, patient liability amounts, and other transactions posted to the account.
• Gather information necessary, i.e. explanation of benefits, to process refunds to the patient/guarantor to include entering refund requests in the patient accounting system and submitting to leadership for approval.
• Coordinate, prepare, and submit quarterly Medicare Credit balance report IAW CMS guidelines.
• Analyze and submit necessary adjustments to be applied to the patient account(s).
• Maintain documentation for all communications, adjustments and refunds for retrieval and tracking purposes.
• Validate check information and account balances prior to issuing refunds.
• Communicate with patients, insurance, and vendors regarding refund requests.
• Serve as first level of escalation for patient /insurance calls. Log necessary information to work refund requests and provide these customers with status of their request.
• Process refunds requested by patient within five (5) working days of receipt/request.
• Review and respond to written correspondence for nature of refund request and coordinate with appropriate department(s) to aid in review and determination of refund processing.
• Coordinate with leadership on team performance and metrics to determine opportunities for improvement.
• Demonstrate the ability to work independently while completing tasks by deadline.
• Maintain compliance with all company policies, procedures, and standards of conduct.
• Perform other duties as assigned.

Education:

• High School Diploma, or GED (required).

Experience:

• 2-3 years experience in AR Operations, accounting, or equivalent experience (required).
• 5 years or more experience with revenue cycle operations and performing account resolution (preferred)

Knowledge, Skills, and Abilities 
• Ability to review, comprehend, and discuss Facility billing with Insurance or Government agencies.
• Knowledge of general insurance requirements to include coordination of benefits.
• Knowledge of CPT/HCPCs, APCs, MS-DRGs, revenue codes, modifiers, and billing regulations.
• Experience working directly with EOBs, contractual adjustments, and payer contracts.
• Ability to calculate rates using reasoning and mathematical skills.
• Organizational and documentation skills to ensure timely follow-up and accurate record keeping.
• Ability to identify priorities and effectively manage short notice changes by leadership.
• Strong self-motivation to achieve goals and meet productivity expectations.
• Strong team player with attention to detail and desire to help others.

Language Ability:
• Must be able to communicate effectively in both verbal and written formats.

Reasoning Ability:
• Ability to read and interpret documents, i.e. contracts, claims, instructions, policies and procedures in written (in English) form.
• Ability to define problems, collect data, and establish facts to execute sound financial decisions regarding patient account(s).
• Ability to analyze and interpret information on electronic remittances (ERA)/ Explanation of Benefits (EOB).

Computer Skills:
• Moderate to advanced computer proficiency including MS Excel, MS Word and MS Outlook.
• General computer knowledge and working with electronic filing systems.

Additional Responsibilities:
• Demonstrates a commitment to service, organization values and professionalism through appropriate conduct and demeanor at all times.
• Maintains confidentiality and protects sensitive data at all times.
• Adheres to organizational and department specific safety standards and guidelines.
• Works collaboratively and supports efforts of team members.
• Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community.