Credit Balance Review Specialist (Medical Insurance)

About Us

Emerus is the nation's first and largest operator of small-format hospitals, also known as community or neighborhood hospitals. Emerus' leading national health system partners include Allegheny Health Network, Ascension, Baptist Health System, Baylor, Scott & White Health, Dignity Health St. Rose Dominican, The Hospitals of Providence, INTEGRIS and MultiCare. Our state-of-the-art hospitals are fully accredited and provide highly individualized care. From the moment a patient walks through the door, a team of exceptional medical professionals takes charge, treating patients with speed, compassion and expertise. Emerus' distinctive level of care earned the Guardian of Excellence Award for Superior Patient Experience in six of the past seven years. More information is available at www.emerus.com.

Position Overview

The Credit Balance Review Specialist is primarily responsible for monitoring and resolving credit activity that is housed in the patient accounting system as well as refund request letters received from governmental and commercial carriers. The Credit Balance Review Specialist will review the patient's account to include; charges, accuracy of reimbursement to expected reimbursement and how that payment was posted to the billing system to determine if a true credit exits. If a refund is required, the Credit Balance Review Specialist will complete the appropriate refund form.  The Credit Balance Review Specialist will identify trends that exist, the root cause for credits, and collaborates with the appropriate parties to minimize refunds. The Credit Balance Review Specialist reports to the Patient Account Manager.

Essential Job Functions

• Research Credit Balances on patient accounts
• Determine the correct course of action to resolve the refund request or Credit Balance which could include but not limited to:
  • Accurate completion of refund request for submission to refund department.
  • Requesting payment corrections or adjustment corrections as needed.
  • Requesting transfer of patient payments to other patient accounts that have patient balances that may reside in patient accounting system.
• Work closely with third-party payors throughout the refund and credit issue resolution process.
• Maintain knowledge of insurance payments and rejection/denial processes.
• Update Credit Balance/refund reports as necessary
• Notify payor representative to initiate takeback (recoupment) and provides support documentation as required to the payor representative.
• Provides all required documentation necessary for refund approval.
• Submits validated refund request documents for Lead review and approval.
• Ensures complete, accurate, and timely account notation and documentation in the patient accounting system, including adjudication and denial processing.
• Works closely with the Team Leads of the CBO

Other Job Functions

• Attend staff meetings or other company sponsored or mandated meetings as required
• Perform additional duties as assigned

Basic Qualifications

• High School diploma or GEC equivalent, required
• 2+ years prior related Healthcare Facility Revenue Cycle experience, preferably with Credit Balance resolution, required
• Experience in account inquiries and analysis to investigate and evaluate the payment methodology and accuracy, required
• Clear understanding of contract terms, payer policy, and strong understanding of explanation of benefits.
• Excellent written, verbal communication and interpersonal skills.
• Ability to work independently, prioritize work and results oriented.
• Must possess a strong math aptitude.
• A demonstrated ability to use office productivity tools such as Microsoft Outlook, Word, and general computer skills necessary to work effectively in an office environment.
• A demonstrated ability to use Microsoft Excel to download reports and manipulate data using formulas and pivot tables.

Employment Type: FULL_TIME