Overpayment Specialist

Overpayment Specialist

The Overpayment Specialist (OVPS-I) is assigned a group of credit balances and is responsible for accurately and efficiently resolving the open claims. Additionally, this individual will review EOB's, contracts and/or other supporting documentation to determine if payments need to be refunded or if balances can be adjusted in accordance with policies and procedures, including federal, state and local standards, guidelines, and regulations. Hybrid, on-site (Franklin, TN or Beverly, MA), or remote candidates will be considered.

Essential Functions:

• Work credit balances for any financial class and insurance grouping including Self Pay, Commercial, Federal and State insurance plans.

• Work and track refunds via refund portal for the states that require live checks.

• 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 on a regular basis and reviews for any issues.

• Answer phone calls from patients, insurance companies and collections agencies and manage refund requests according to process and procedures.

• Follow up on returned/voided checks.

• Meet 30-day credit review expectation and clearly 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 business implications of decisions.

• Perform other tasks, duties and projects as requested by Management.

Position Type, Expected Hours of Work & Travel:

This is a full-time, hybrid, remote, or on-site (Franklin, TN or Beverly, MA) position. Office hours are Monday through Friday, 8:30 AM to 5:00 PM EST. Hours of work are based on regions supported. Travel is not expected with this position.

Required Education and Experience:

• Bachelor's degree with a focus in business or healthcare management preferred. Equivalent combination of education and experience will be considered.

• 0-2 years of experience in accounts receivable, or equivalent work experience with medical insurance providers.

• Experience in dialysis and/or healthcare is preferred.

• Excellent customer service skills, ability to actively contribute as a team player and superior attention to detail required.

• Ability to work in a fast-paced environment while maintaining high standards of accuracy required.

• Flexibility and ability to prioritize while alternating between tasks.

• Adaptability and willingness to consistently learn new skills.

• Proficiency in Microsoft Office Suite required.

• Knowledge of Excel, PivotTable and VLOOKUP required.

Equal Opportunity Employer:

American Renal Associates LLC is an equal opportunity employer and a drug free workplace. All qualified We applicants will receive consideration for employment without regards to race, color, religion, sex, sexual orientation, gender identity, national origin, citizenship, disability, or protected veteran status.

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