**Job Summary:** The Payment Review Representative processes all Medicare, commercial and patient refunds, resolve invoice under-payments and over-payments **Direct Reports:** **0** **Sensitive/ confidential data handled:** **N/A** **Responsibilities** + Evaluate patient accounts for payment status (i.e., who, what, amount paid) against what was returned and what is being refunded. + Resolve invoice under payments and over payments in a timely manner. + Communicate with Medicare directly to assess claims. + Fill out refund forms for accounting for check request. + Credit accounts when necessary, make copies of documents and mail original back-ups along with check to Medicare. + Filing all documents (back-up copies) in appropriately areas. + Complies with all State, Federal, professional regulation as well as department rules, policies and procedural information. + Respond promptly when returning telephone calls and replying to correspondence and faxes. + Verifies that payments received are correct according to the fee schedule. + Applies the payment correctly to the assigned patient accounts. Correctly apply Medicare auto posting checks, patient cash, and adjustments as needed. + Keeps Supervisor and Manager informed of payment/denial trends. + Has the ability to read and interpret an Explanation of Benefits. + Must meet all month end requirements. + Proficient in the knowledge of the equipment and services offered by Company + Works as a part of the company team by communicating effectively with all departments. + Observes legal and ethical guidelines for safeguarding patient and company confidentiality (HIPPA). + Provides exceptional customer service to both internal and external customers. + Interacts in a professional manner with all teammates and customers. + Promotes company’s culture by adhering to policy, procedure, and mission statement. + Completes assigned work in a timely and efficient manner. + Adapts to and demonstrates the ability to deal with frequent changes in the work environment. + Meets individual, departmental, and company goals. + Other duties as assigned. **Job Specification** **Medical insurance billing knowledge and coding language skills** + Thorough understanding of claims reimbursement process – denials and cash posting + Proficient Medicare and solid general payers' knowledge **Research, review and analysis skills** + Understand physician diagnosis choices, apply the appropriate codes for billing purposes, detect mistakes and make other decisions related to insurance billing. Study medical terminology, anatomy and disease treatments to create a solid foundation of medical knowledge. **Reading and data entry typing skills** + Keying data and communicating via computers. Typing using computer keyboards, 10-key pads and calculators. Attention to details, as misspelling names, entering incorrect billing codes or description abbreviations, and mistyping money amounts can result in costly errors. **Written and oral communication skills** + Must be able to interact effectively with medical personnel, insurance companies, and patients over the phone and by email to discuss accounts, handle payments and resolve problems. Able to communicate with clear and concise language and a professional tone. Additionally, active listening and note-taking skills. **Technology skills** + Basic office skills, use of copiers, printers, scanners and fax machines. Skills related to word processing or spreadsheet software, needed to draft letters and bills, print documents, and communicate with insurance, billing and doctors’ offices. **Minimum Qualification:** + _High school diploma or GED required_ + _Associate degree preferred_ + _Preferred years of experience – Level I 1 to 3 years, Level II 3 to 5 years_ + _Excellent verbal and written communication skills, including ability to effectively communicate with internal and external customers._ + _Excellent computer proficiency (MS Office – Word, Excel and Outlook)_ + _Must be able to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service_ + _Ability to work independently and to carry out assignments to completion within parameters of instructions given, prescribed routines, and standard accepted practices_ An Equal Opportunity Employer Abbot welcomes and encourages diversity in our workforce. We provide reasonable accommodation to qualified individuals with disabilities. To request accommodation, please call 224-667-4913 or email corpjat@abbott.com