Fraud Claims Operations Representative Jobs in Washington

Position Objective:

Under the supervision of the Cash Operations Manager, the Cash Operations Representative is responsible for the validation and reconciliation of money and processing of all payments, adjustments, denials accurately and timely for all professional fee billing.  Determines if applied payments should be refunded; monitors credit work queues and resolves credit balances stemming from over posted adjustments, payments.   Researches patient's accounts on all requested refunds and completes necessary paperwork and process to finalize refunds.
Essential Job Duties:

The Cash Operations Representative is responsible for bank reconciliation and accurate posting of payments , adjustments, denials , recoupments and refunds while adhering to compliance, policies and regulations.

Responsibilities:

1. Records monies received in multiple bank accounts and lock boxes daily and reconcile the posting of money to current and legacy AR systems on a daily and monthly basis accurately.
2. Receives and records all electronic and non-electronic payments from lockbox or other locations daily.
3. Identifies system payments and works with Cash Operations Lead/Manager to communicate funds received. Prepares and submits journal entries or money reclassifications for accuracy daily to Cash Operations Lead/Manager.
4. Reconciles all payment, adjustment and refund batches to the daily journal. Resolves any out of balance batches before closing. Responsible for reporting to Cash Operation Lead/Manager any problems or issues on the monthly reconciliation.
5. Validates receipt and loading of electronic remittance files, resolves errors according to policy and procedure and accepts files to post payments electronically daily.
6. Post, reviews, scans and disburses self-pay and insurance lock box documents to appropriate resources/ external teams/units timely.
7. Maintains manual posting batches chronologically by date of entry to the system to facilitate quick and easy access.
8. Posts all manual payments, adjustments, denials and recoupments manually and electronically to the correct patient account/ invoice. 
9. Transfers secondary balances to the correct payer or patient as the account and payers' explanations of benefits dictates. Forwards copies of rejections or incorrect payments to the Accounts Receivable Specialist for research and resolution.
10. Performs other duties as assigned.

Educational/Experience Requirements:

• High School Diploma or equivalent (GED) required.
• Excellent intrapersonal and communication skills required to and the ability to work collaboratively in a team setting as well as external vendors /departments and units.
• Two or more years of experience performing the posting of self- pay and insurance payments, adjustments, denials and correspondence manually and electronically preferred.
• Multi-division cash application processing experience with knowledge of lockbox manual and electronic file processing and banking reconciliation for multiple bank accounts. 
• Highly organized  and flexible with the ability to re prioritize work  and accept new  or different assignments daily as needed to ensure completion of work..

Preferred Qualifications:

• EPIC Cash Management Tool and payment posting module experience preferred
• Experience working with lock box conversion vendors preferred.
• Experience and knowledge in overall claims processing and insurance follow up collections preferred in a health care institution or multiple physician practice shared services environment.

• Intermediate Microsoft Excel skills and perform independently is preferred.

Working Conditions, Equipment, Physical Demands:

There is a reasonable expectation that employees in this position will not be exposed to blood-borne pathogens.

Physical Demands -

Light Duty

The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.

The above job description is an overview of the functions and requirements for this position.  This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary.