Payment Integrity And Refund Specialist

Come join an exciting and innovative company that puts the “care” back in healthcare!

At KabaFusion, our patients come from all walks of life and so do we. We hire GREAT people, period! Our culture celebrates and supports the differences that make us unique. Here, it doesn’t matter what your role is, your hard work and dedication is not only recognized but celebrated. Join us and find out why this is the place to excel and do your best work. 

About Us:  

What started as a single pharmacy in 2010 has grown into KabaFusion becoming the largest privately held home infusion company in the country. We have a national network of pharmacies and nursing offices strategically placed to service 40+ states. Couple that with over 30 years of combined experience and it’s no wonder why KabaFusion is the industry leader in home infusion. 

JOB SUMMARY:

This position is responsible for ensuring accurate and compliant billing processes across Government, Commercial Health Plans, and Medical Group payers while managing claims resolution and refund processing. The position also involves analyzing payer correspondence, escalating trends, maintaining contractual compliance, and addressing reimbursement issues promptly.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

1. Assures billing processes are compliant with payer requirement for Government, Commercial Health Plans and Medical Group payers.

2. Escalate credits to Level II Payment Integrity/Refund Representative, Sr. Payment Integrity/Refund Representative and/or upper management when seeing a trend by payer.

3. Analyze and rectify claims issues with payers by timely follow up of correspondence/ refund letters received from payers.

4. Reviews and assures claims are processed and paid in full according to contractual agreements.

5. responsible for accurate and timely follow up when processing payer and patient refunds, including submitting refund requests forms to Reimbursement Supervisor for review.

6. Ensures revenue is booked according to appropriate contract allowable.

7. Communicates and addresses reimbursement issues with Lead/Supervisor for resolution in a timely manner.

8. receiving correspondence and documenting on the Refund Request Log, as well as scanning in document manager.

9. Handles calls regarding refund requests promptly with professionalism to payers.

10. Ensures daily productivity is met, minimum of 30-35 claims worked per day.

11. Other related duties as assigned by manager or designee.

JOB REQUIREMENTS AND QUALIFICATIONS

Education:

• High School Graduate or Equivalent.

Experience

• Minimum of one (1) year of experience in home infusion.

• Proficient experience with Microsoft Office including Word, Excel, Outlook, Teams, and/or electronic health care record software system preferred.

Skills and Competencies:

• Knowledgeable of HCPC and CPT codes.

• Demonstrate the ability to prioritize and meet goals and deadlines.

• Demonstrate strong attention to detail and productivity standards.

• Demonstrate the ability to work with minimal supervision.

• Demonstrate strong understanding of insurance terms, medical terminology, pricing methodology for commercial and government billing requirements.