Payment & Refund Control Specialist at ABCS, Inc.

The Payment & Refund Control Specialist is responsible for daily validation of multiple claims payment cycles, which includes accurate, efficient and timely end-to-end processing of claims refunds and stop payment requests. The payment activities include, but are not limited to, timely balancing and verifying payment data (daily and monthly adjudication controls to check register), evaluating the results of claim adjustment transaction on payments, assisting with problem resolution with the appropriate information systems staff, and communication of same to various operational areas EDUCATION High School diploma or equivalent. EXPERIENCE Minimum one (1) year recent bookkeeping or account receivable experience. Microsoft Excel experience required. Claims processing or claims adjustment experience preferred. ESSENTIAL SKILLS & ABILITIES Account Receivable Multitasking Logical Thinking Mathematics Problem Solving Customer Service Oral & Written Communication Strong Interpersonal Communication Analyze Information Professional Judgment ADDITIONAL JOB DESCRIPTION Highly Organized Detail Oriented Time Management Confidentiality Highly Motivated Self-Starter Microsoft Office Suites including Excel & Word Proficiency using computer applications, which includes spreadsheets, word processing, and database applications. Ability to Work Independently or as a Team. REQUIRED: Works closely with Claims and Customer Service Operations, providers, and occasionally members to resolve problems and respond to inquiries regarding payments and refunds. Assists in other duties, as assigned Performs daily validation of multiple claims payment cycles, which includes accurate, efficient and timely end-to-end processing of claims refunds and stop payment requests in accordance to corporate policies, audit requirements, and operational procedures and standards. Checks returned by providers or members and undeliverable checks must be controlled and disposed timely. Interprets and adheres to all regulations and policies related to overpayments to ensure compliance. This may vary depending on reason, type of claim overpayment and line of business. Coordinates the overpayment correspondence function, which includes the creation and delivery of Check Control memos in a timely manner. Initiates systematic releases of payment materials to print and mail operations. Maintains awareness of corporate fiscal policy and fiscal administration guidelines and the impact on financial reporting of the Enterprise.