Refund QA Specialist

• Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, and now radiology, through the recent combining of forces with Advocate RCM. Focused on Revenue Cycle Management and Advisory services, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities.

• The RCM (Revenue Cycle Management) Refund QA (Quality Assurance) Specialist, your primary responsibility is to ensure accuracy and compliance in the refund processes within the healthcare revenue cycle. You will play a crucial role in reviewing and validating refund transactions to guarantee adherence to industry standards, regulations, and organizational policies. This role requires a meticulous eye for detail, strong analytical skills, and a comprehensive understanding of healthcare billing and reimbursement.

Refund Transaction Review:

• Conduct thorough reviews of refund transactions to ensure accuracy, completeness, and compliance with established guidelines.
• Analyze supporting documentation to validate the legitimacy of refund requests and ensure proper authorization.

Quality Assurance:

• Implement and maintain quality assurance processes for refund transactions, focusing on data accuracy and compliance with regulatory requirements.
• Develop and execute testing protocols to identify potential errors or discrepancies in refund processing.

Documentation and Reporting:

• Maintain detailed records of refund reviews, findings, and corrective actions taken.
• Generate regular reports summarizing the results of QA activities and provide insights to management for process improvement.

Compliance Monitoring:

• Stay current with healthcare regulations, payer policies, and industry best practices related to refunds and reimbursement.
• Ensure that refund processes align with relevant laws and regulations, such as HIPAA and other healthcare compliance standards.

Communication and Collaboration:

• Collaborate with internal teams, including billing, coding, and finance, to resolve any discrepancies identified during the QA process.
• Communicate QA findings and recommendations to management and participate in discussions to improve refund processes.

Training and Development:

• Assist in the development and delivery of training programs for staff involved in refund processing to enhance their understanding of QA requirements and compliance standards.

Continuous Improvement:

• Proactively identify areas for process improvement within the refund workflow and contribute to the development and implementation of solutions.

• Bachelor's degree or related field (preferred).
• Minimum 4 years+ proven experience in revenue cycle management, healthcare billing, or refund processing.

• Strong knowledge of healthcare billing processes, insurance terminology, and revenue cycle workflows.
• Strong understanding of healthcare regulations and compliance standards.
• Excellent analytical and problem-solving skills.
• Detail-oriented with a high level of accuracy in work.
• Effective communication skills for collaboration and reporting.
• Knowledge of relevant software and systems used in revenue cycle management.

Equal Employment Opportunity (Applicable only in the US)

Ventra Health is an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity and expression, or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities, as needed, to assist them in performing essential job functions.

Recruitment Agencies

Ventra Health does not accept unsolicited agency resumes. Ventra Health is not responsible for any fees related to unsolicited resumes.

Solicitation of Payment

Ventra Health does not solicit payment from our applicants and candidates for consideration or placement.

Attention Candidates
Please be aware that there have been reports of individuals falsely claiming to represent Ventra Health or one of our affiliated entities Ventra Health Private Limited and Ventra Health Global Services. These scammers may attempt to conduct fake interviews, solicit personal information, and, in some cases, have sent fraudulent offer letters.

To protect yourself, verify any communication you receive by contacting us directly through our official channels. If you have any doubts, please contact us at Careers@VentraHealth.com to confirm the legitimacy of the offer and the person who contacted you. All legitimate roles are posted on https://ventrahealth.com/careers/.