Purpose:

Do you have experience with medical billing? Are you knowledgeable on healthcare insurance? UPMC Corporate Revenue Cycle is looking to hire a full-time Refund Specialist to support the Credits department. The Refund Specialist is responsible for processing all credit balances (insurance and self-pay) for refunds. This role would work Monday through Friday from 7:00am until 3:30pm. This position would be located at the Quantum One Building, however opportunities to work from home available after training and productivity requirements are met.

If interested in this opportunity, apply today!

Responsibilities:

• Review credit balances for possible distribution to other debit balances.
• Ensure that all validated Government payer refunds are processed in a timely manner or within the payer guidelines.
• Maintain department productivity guidelines.
• Ensure that proper documentation is attached to all refund requests.
• Perform duties and job responsibilities in a manner which promotes the core values of UPMC (Quality and Safety, Dignity and Respect, Caring and Listening, Excellence and Innovation, Responsibility and Integrity) in all consumer and UPMC interactions.
• Maintain compliance with quality standards.
• Prioritize workflow accordingly by balance and aging criteria.
• Ensure that all incoming refund requests, either via CRM or email, are processed within 3 business days.
• Identify and take action towards resolution of credit accounts through potential refunds, adjustments, payment transfers, etc. Adhere to the Fair debt Extension Uniformity Act and understand the laws and regulations applicable to job functions.
• Identify credit balance issues that may impact workflow.
• Reconcile refund postings.
• Notify management of any trends identified in workflow creating credit balances.

• High School diploma or equivalent and 1 year of claims processing, billing, or collections experience, OR High School diploma or equivalent and 3 years of experience in a business office setting. Bachelor's degree is preferred.
• Knowledgeable in third party payer guidelines and reimbursement practices required.
• Effective problem-solving skills and ability to make independent decisions required.
• Good oral and written communication skills.
• Knowledge of medical terminology, third party payer guidelines, and reimbursement practices.
• Experience or working knowledge of Microsoft Office products (Word, Outlook, Excel) preferred but not required.
• Strong understanding of all patient accounting systems.

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran