Patient Financial Services Collection/Refund Specialist

  • San Leandro, CA
  • Finance
  • Patient Financial Svcs - Pro
  • Full Time - Day
  • Req #: 26834-17807
  • Posted: May 19, 2020
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SUMMARY: The PFS Collection/Refund Specialist is responsible for all aspects reviewing payer contracts, claims and performing third party refund activity for Professional Fee services.

DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: The following are the duties performed by employees in this classification, however, employees may perform other related duties at an equivalent level.  Not all duties listed are necessarily performed by each individual in the classification.

1.  Performs refund and credit analysis, audit and reimbursement functions for all patient credit balance accounts.

2.  Responsible for the review, preparation and submission of the Credit Balances Quarterly Report.

3.  Responsible for follow up on applicable credit balance accounts.

4.  Responds to patient Insurance phone calls regarding account balances and refunds.

5.  Handle correspondence received from payers requesting refunds.

6.  Reports on root causes of Credit Balances to management.

7.  Interacts with all campuses to resolve accounts.

8.  Responsible for all aspects of Professional Fee follow up and collections on insurance balances, including making telephone calls, accessing payer websites.  Identify issues or trending and provide suggestions for resolution.  Accurately and thoroughly documents the pertinent collection activity performed.  Review the account information and necessary system applications to determine the next appropriate work activity.  Verify claims adjudication utilizing appropriate resources and applications.  Initiate telephone or letter contact to patients to obtain additional information as needed.  Perform appropriate follow-up functions, including manual re-submissions as well as electronic attachments to payers.  Manage and maintain desk inventory, complete reports, and resolve high priority and aged inventory.

9.  Respond timely to emails and telephone messages as appropriate.  Communicate issues to management, including payer, system or escalated account issues.

10. Maintains information or operational records; screens reports for completeness and mathematical accuracy; list, abstracts, or summarizes data; compiles routine report from a variety of sources.

11. May, as a secondary responsibility, interpret abstracts, orders, notes, invoices,  permits, licenses, etc.; computes and receives fees when the amount is not in question or is readily obtainable from fixed schedules; posts data; and prepares reports in accordance with pre-determined forms and  procedures.

12. Prepares documents for collection of revenues from third party payer programs; checks and verifies charge rates for services; reconciles account balances and verifies payments.

13. Reviews billing documents to assure program compliance for Medicare, Medi-Cal, Managed Care, Mental Health and insurance payer programs; assures that all appropriate medical documentation is included in the billing package.

14. Assures that all appropriate medical documentation is submitted timely.

15. Other duties as assigned.


Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.

Required Education: High school diploma or equivalent education.

Minimum Experience: One year of experience in a Revenue Cycle area within the Alameda Health System; OR the equivalent of two years’ experience, performing medical billing/collections or medical accounts receivable functions in a healthcare insurance related environment.


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