Guidehouse is a leading global provider of consulting services to the public sector and commercial markets, with broad capabilities in management, technology, and risk consulting. By combining our public and private sector expertise, we help clients address their most complex challenges and navigate significant regulatory pressures focusing on transformational change, business resiliency, and technology-driven innovation. Across a range of advisory, consulting, outsourcing, and digital services, we create scalable, innovative solutions that help our clients outwit complexity and position them for future growth and success. The company has more than 12,000 professionals in over 50 locations globally. Guidehouse is a Veritas Capital portfolio company, led by seasoned professionals with proven and diverse expertise in traditional and emerging technologies, markets, and agenda-setting issues driving national and global economies. For more information, please visit www.guidehouse.com.
The Refund Representative, under general supervision and according to established policies and procedures, performs a variety of duties related to processing of overpayments made to the Management Services Organization (MSO). Such duties may include, but are not limited to; processes overpayment requests, post contractual adjustments, write offs, or transfers accordingly to resolve credit balances, resubmits claims and supporting documentation as needed, and communicates with third party payers in response to overpayment request and/or to obtain insurance hierarchy information. Communicates issues to management timely. Performs other duties as assigned by direct supervisors.
+ Must be self-directed / self-motivated; must have good communication and interpersonal skills.
+ Perform a variety of duties often changing from one task to another of a different nature without loss of efficiency or composure.
+ Accept responsibility for one’s own work; works independently.
+ Recognize the rights and responsibilities of patient confidentiality.
+ Convey empathy and compassion to those experiencing pain, physical or emotional distress and/or grief.
+ Relate to others in a manner which creates a sense of teamwork and cooperation.
+ Communicate effectively with people from every socioeconomic, cultural and educational background.
+ Exhibit flexibility and cope effectively in an ever-changing, fast-paced healthcare environment.
+ Perform effectively when confronted with emergency, critical, unusual or dangerous situations.
+ Demonstrate the quality work ethic of doing the right thing the right way.
+ Maintain a customer focus and strive to satisfy the customer's perceived needs.
+ Analyze credit balance invoices for resolution.
+ Analyze insurance and patient overpayments for resolution.
+ Update patient insurance information and file claims as necessary.
+ Works refund requests received from third party payers, other departments.
+ Processes various reports pertaining to credit balances.
+ Key transactions necessary to resolve credit balance.
+ If no refund due, post appropriate adjustment or transfer.
+ If refund due, post in AES, batch and submit to supervisor for processing or approval.
+ Key insurance refunds on-line to appropriate payers as necessary.
+ Balance all refund batches daily and submit to Supervisor for processing.
+ Other duties as assigned by management.
+ High school diploma or equivalent.
+ Two years of related experience and general knowledge of payer-specific or medical specialty billing.
+ Knowledge of CPT and ICD-10 coding
+ The successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described.
+ CPC preferred
+ Good written and verbal communication skills.
+ Basic computer skills
+ Due to our contractual requirements, to be eligible for this role, you must be fully COVID-19 vaccinated at time of hire.
Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.
Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.
If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.
Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.
Rewards and Benefits
Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.
+ Medical, Rx, Dental & Vision Insurance
+ Personal and Family Sick Time & Company Paid Holidays
+ Position may be eligible for a discretionary variable incentive bonus
+ Parental Leave and Adoption Assistance
+ 401(k) Retirement Plan
+ Basic Life & Supplemental Life
+ Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
+ Short-Term & Long-Term Disability
+ Tuition Reimbursement, Personal Development & Learning Opportunities
+ Skills Development & Certifications
+ Employee Referral Program
+ Corporate Sponsored Events & Community Outreach
+ Emergency Back-Up Childcare Program