Required Education and Experience: High School graduate with a minimum of 2 years’ experience in a medical business office or a related field. Experience with the claim adjudication process for government and commercial insurance carriers. Basic medical terminology, CPT and ICD codes.

Additional Eligibility Qualifications: Basic knowledge of Windows based computer applications. Be able to operate the following equipment: computer, copier, fax, and 10-key calculator. Accurate typing rate of 40 WPM. Aptitude to retain detailed information. Ability to be multi-tasked oriented, to prioritize and produce an acceptable volume of work. Knowledgeable concerning basic telephone etiquette. Has a good speaking voice, able to communicate ideas in a clear and concise manner. Must be able to conduct thorough interviews concerning financial matters in a relaxed and supportive manner. Ability to assess a situation and decide on the best course of action. Possesses good organizational skills. Professional appearance and manner.

Summary/Objective: Sr. PFS Refund Representative assists in the operations of the Refund Department to ensure compliance and quality processing of credit balances.

Essential Functions

Monitoring the Refund Department staff to ensure accurate processing of credit balances.

Trains and educates Refund staff to adhere to Standard Operating Procedures and provide accurate and timely refunds. Assists staff with in-depth research to ensure the accurate processing of accounts. Addresses staff concerns in relation to the processing of refunds.

Processes all aspects necessary for the completion of compliance audits including research, charge corrections and processing of refunds.

Analyzes escalated requests for patient and insurance refunds requiring in-depth research and processing of the refund.

Assists with the processing of patient and insurance refund requests.