Role Overview
This position focuses on the accurate and compliant management of adjustments and refund activities in the revenue cycle. The specialist ensures financial records reflect proper application of payer rules, contract terms, and internal procedures, supporting both operational accuracy and audit preparedness.
Key Responsibilities
- Review and process adjustments and refunds with precision and timeliness in the billing system.
- Investigate and resolve discrepancies in accounts related to adjustments and refunds to maintain financial accuracy.
- Apply in-depth knowledge of AR follow-up and denial resolution to reduce aging receivables and support clean write-offs.
- Interpret US payer contracts, EOB/ERA codes, and reimbursement guidelines to validate proper financial treatment.
- Stay current with evolving regulations, payer policies, and industry standards affecting adjustments and refund protocols.
- Conduct quality reviews and audits to identify gaps, recommend improvements, and ensure adherence to SOPs.
- Maintain clear, up-to-date documentation of processes, payer-specific rules, and compliance practices.
- Support internal and external audits by providing accurate records and explanations.
- Collaborate in team discussions to enhance workflow efficiency and service quality.
- Apply strong attention to detail when following procedures for adjustments and refund processing.
Qualifications and Skills
Candidates must have at least two years of direct experience in revenue cycle operations within DME/HME. Proficiency in accounts receivable management, denial resolution, and payer reimbursement models—including Medicare, Medicaid, and commercial insurers—is essential. Strong analytical abilities, organizational discipline, and clear communication skills are required to navigate complex financial scenarios and work effectively across teams.
Familiarity with Brightree is highly valued. A background in audit or quality control is beneficial. Candidates should demonstrate the ability to work independently while contributing to team goals, applying company policies to resolve diverse operational challenges.
