Refund Rep

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  • 18-00015
  • Full Time/Contract
  • Billing/Collections
  • Los Angeles, CA
Job Description
Since 1902, our Client’s hospital has focused on providing the highest quality healthcare available and in 2009 was named one of "America’s Best Hospitals . Today, our client delivers word-class medicine to the Los Angeles community and to patients from across the United States and around the world.

To efficiently and effectively bill and collect monies relative to physician reimbursements. The Biller/Collector works on specific types of accounts (e.g. transplant cases, cardiothoracic surgeries and other advanced type of special accounts, Prop 99, etc.) in a team environment to fulfill the mission and goals of the Department. The Biller/Collector will work independently requiring little supervision from management to ensure the integrity of the work performed.


  • Coordinate and follow through on the reimbursement activity for specific patient accounts (e.g transplant cases, cardiothoracic surgery cases, etc).
  • Initiates proactive measures that result in account resolution.
  • Ensures all conditions for payment receipt have been satisfied, which includes, but not limited to:
  • accurate charges patient insurance eligibility
  • accurate financial class patient benefit coverage
  • authorization/certification/TAR information patient responsibilities
  • claims address CPT 10 coding, as applicable
  • ICD 10 coding, as applicable
  • Responds timely and accurately to all incoming related correspondence and inquiries from payers, patients and other authorized parties. Reports any trends in incoming correspondence to managers for appropriate follow-up.
  • Interacts with co-workers and other representatives to obtain required information on a timely basis.
  • Initiates contact with patients as necessary
  • Initiates recommendations and actions for resolving patient accounts. Evaluate accounts to determine any write-offs or corrections required, including duplicate charges.
  • Submit bills to insurance for secondary insurance.
  • Ensure that all necessary documentation and information is correct according to departmental policies and procedures. Ensure that all documentation is complete for submission to determine ultimate action on patient account.
  • Ensure that all applicable monies are transferred from the hospital so that they may be posted accordingly.
  • Answer telephones, patient inquiries, and respond appropriately to written correspondence relative to a patient’s account.
  • Research and prioritize incoming mail, resubmit denials with proper documentation according to departmental policies and procedures.
    Verify correct initial subscriber billing information and update information in the system as necessary.
  • Prepare refund request for any or all monies due to patient or insurance company as a result off overpayments or forward requests to appropriate individual in charge of processing refund requests.
  • Post adjustments to accounts in accordance with departmental policies and procedures.
  • Respond to all phone calls from other departments or insurance companies in an efficient and courteous manner.
  • Demonstrate teamwork and provide assistance with special projects when assigned.
  • Create correspondence and provide documentation for effective reimbursements.
  • Responsible for updating information within the IDX system via BAR and PCS (charges, adjustments, write-offs, bad debt, refunds to patients/insurance companies, and professional courtesies). Responsible for processing non-sufficient funds checks and ensure follow-up with those patients in this categories.
  • Clearly document within the patient’s account, actions taken on the account and any other follow-up that was done, including what the expected outcome should be.


  • High School graduate or equivalent required
  • Minimum four (4) years’ experience performing physician A/R follow up functions
  • Minimum experience includes corresponding with patients and insurance companies in resolving patient accounts.
  • Extensive knowledge of insurance carrier procedures. Experience with reading Explanation of Benefits (EOB) statements. Proven ability to handle multiple conflicting tasks.
  • Experience with on-line Accounts Receivable system (EPIC system experience a plus). Knowledge of PC based software applications (e.g. Word for Windows, Excel, etc). Type 35+ wpm.
  • Ability to communicate effectively in both verbal and written form. Ability to work in a changing environment and handle multiple conflicting priorities.

Commensurate with Experience
Monday – Friday (days)

Full Time
Contract to Hire


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