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Credit Balance Spec

Credit Balance Spec

Job Description

Responsible performing accounts receivable analysis and resolution of credit balance patient accounts, including refund requests and contractual allowance corrections.  Responsible for ensuring third party and patient claims with credit balances are resolved accurately and timely by utilizing Managed Care contracts and revenue cycle processes.  Provides support and assistance to the PFS (Patient Financial Services) Manager as directed.  Compliance with all departmental, institutional and regulatory policies and procedures is required at all times.                                                                                                                                         
Essential Functions:                                                                                       

Performs detailed analysis on credit balance accounts.  Collects necessary documentation to determine if either a refund is due to patient/third party payer or an adjustment/correction is needed on a previous contractual allowance.  Detailed research of the account will include a strong understanding of Managed Care contracts and working with the Denial's Management team to interpret any denials on the account before approving or denying a refund request.

Researches all assigned accounts with credit balance to determine the root cause for the credit balance and the appropriate actions needed to address the account.      
Completes appropriate activities required to process a refund to a patient or a third party payer according to departmental/payer procedure and timelines to avoid recoupments.
Completes necessary adjustments to an account to correct transactions that may be inappropriately creating a credit balance on the account using payer contract knowledge.
Documents patient accounts appropriately updating the account with appropriate transactions to reflect current status.
Organizes work/resources to accomplish objectives and meet deadlines while maintaining compliance with federal, state and local regulations, HIPPA and the Corporate Responsibility Program.
Maintains the privacy and security of all confidential and protected health information by using and disclosing only that information which is necessary to perform the function of the job.                                                                                                                                                                                                                         

Job Requirements

High School Diploma or GED required.

3-5 years of patient financial services experience in a healthcare environment preferred.  College degree or courses in Health Information Management (or related field) will be considered in place for some of the experience.                                                                                                                                         

Knowledge of insurance regulations, adjudication guidelines and policies and the ability to understand Managed Care payer contracts is required.  Excellent phone etiquette and internal/external customer service skills required.                                                                                                                                               

Business courses such as medical terminology, accounting, finance, cash applications and knowledge of insurance companies preferred.                                                                                                                                   

Job Snapshot

Employment Type Full-Time
Job Type Finance, Accounting
Education High School
Experience 3 to 5 years
Manages Others Not Specified
Industry Healthcare - Health Services
Required Travel Not Specified
Job ID 26600-86580
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Credit Balance Spec

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