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Payment & Refund Control Specialist I

Arkansas Blue Cross & Blue Shield
United States, Arkansas, Little Rock
601 South Gaines Street (Show on map)
Jan 06, 2025
To learn more about Arkansas Blue Cross and Blue Shield Hiring Policies, please click here. Applicants must be eligible to begin work on the date of hire. Applicants must be currently authorized to work in the United States on a full-time basis. ARKANSAS BLUE CROSS BLUE SHIELD will NOT sponsor applicants for work visas in this position. Arkansas Blue Cross is only seeking applicants for remote positions from the following states: Arkansas, Florida, Georgia, Illinois, Kansas, Louisiana, Minnesota, Mississippi, Oklahoma, South Carolina, Tennessee, Texas, Virginia and Wisconsin. Workforce Scheduling Job SummaryThe 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 Requirements 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 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. SkillsAccount Receivable (Inactive), Analyze Information, Confidentiality, Customer Service, Detail-Oriented, Group Problem Solving, Highly Organized (Inactive), Logical Thinking, Mathematics, Microsoft Office Suites including Excel and Word (Inactive), Multitasking, Oral Communication (Inactive), Professional Judgment, Self-Starter, Strong Interpersonal Communication (Inactive), Time Management, Written Communication ResponsibilitiesAssists in other duties, as assigned, 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., 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., Maintains awareness of corporate fiscal policy and fiscal administration guidelines and the impact on financial reporting of the Enterprise., 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., Works closely with Claims and Customer Service Operations, providers, and occasionally members to resolve problems and respond to inquiries regarding payments and refunds. Certifications Security Requirements This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual. Segregation of Duties Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual. Employment TypeRegular ADA Requirements 1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.