Job Title: Overpayment Recovery Specialist
Department: Credit Balance
Location: San Antonio, Texas (on site)
Reports To: Senior Manager, Patient Account Services
FLSA Status: Non-exempt
Summary of Position:
The Overpayment Recovery Specialist is responsible for managing overpayment requests and recoupment processes within the Radiology billing department. This role involves utilizing specific portals to handle documentation for overpayment claims, ensuring timely responses, and verifying that adjustments are posted correctly according to fee schedules. The specialist must have a thorough understanding of bundling, MPPR (Multiple Procedure Payment Reduction) adjustments, multiple surgical adjustments, and relevant fee schedules. The position requires close coordination with various departments to address and resolve overpayment issues efficiently.
Job Responsibilities:
• Manage and process overpayment requests through specific insurance company portals.
• Ensure all overpayment claims are handled in a timely and accurate manner.
• Monitor and track overpayment cases to ensure proper documentation and resolution.
• Handle and review documentation for overpayment claims, ensuring completeness and accuracy.
• Prepare and provide required supporting documents such as medical reports and coordination of benefits.
• Maintain organized records of all overpayment transactions and communications.
• Respond to overpayment requests and related inquiries promptly.
• Ensure that all necessary information is provided within the required timeframe to facilitate claim resolution.
• Familiarize with and apply knowledge of bundling, MPPR adjustments, and multiple surgical adjustments.
• Review recoupments automatically offset from payments by insurance companies to ensure no prior documentation is missing.
• Determine the appropriate department for processing each recoupment case.
• Verify that adjustments are posted correctly according to the appropriate fee schedules within our Billing System.
• Ensure that all billing adjustments comply with current fee schedule guidelines.
• Coordinate with various internal departments to manage and resolve overpayment and recoupment issues.
• Communicate effectively with insurance companies to resolve discrepancies and obtain necessary information.
• Identify opportunities for process improvements to enhance the efficiency and accuracy of overpayment management.
• Provide input on improving policies and procedures related to overpayment and recoupment handling.
• Generate reports on overpayment and recoupment activities, summarizing key metrics and trends.
• Report on the status of overpayment resolutions and any issues encountered during the process.
• Outbound calls to patients to resolve any requests or issues
• Assist as a backup for Cashier as needed
• Required to meet departmental quality and production standards
• Contribute to the team culture in a positive manner
• Perform other duties as required
Supervisory Responsibilities:
None
Experience / Skill Requirements:
• Exceptional written and verbal communication skills
• Organizational skills, able to prioritize
• Minimum of 6 months of experience in medical billing, specifically in handling overpayments and recoupments.
• Computer skills to include Google Suite or similar software
• Type at least 30 wpm and proficient in 10-key by touch
• Ability to read and understand explanation of benefits (EOBs)
• Provide quality customer service - problem solving and decision making
• Must be able to multitask and be a team player
• Maintain confidentiality at all times
• Perform other duties as required
Education:
High School Diploma or GED
Associates degree preferred
Attendance / Work Schedule:
Maintaining and satisfying minimum attendance requirements is an essential function of this position, including working all full-time regular hours as established for this position and scheduled or emergency overtime. Full-time regular hours are defined as Monday through Friday, with after-hours or weekends as required. All employees in this job classification are required to satisfy this requirement. This job classification does not include "light duty" work or allow unpredictable or unrestricted absences.