Credit Balance Analyst | Refunds Department | Days | Full-Time

Jacksonville, United States

Overview:

Summary:

Review and analyze Self-pay and Insurance account credit balances, to ensure accurate resolution by distributing/un- distributing, transferring and/or refunding funds as appropriate for both Physician and Hospital charges.

Responsibilities:

Responsibilities:

The Credit Balance Analyst must understand State and Federal Payor Guidelines.

Track refund completion by ensuring all stages of the refund process is followed.

Provide explanations for account status(es) for incoming inquiries received via; Electronic correspondence (Epic Correspondence Module), Fax transmittals, email and/or phone calls.

Provide timely responses to refund requests from Internal and/or External business partners, such as insurance companies, Revenue Cycle Teams, Patient Service Representatives, Collections, Clinics etc.

When applicable, contact patients and/or insurance companies to verify "Pay to" information and validate mailing addresses.

Performs all other duties that may be assigned in the best interests of the team and the company.

Apply knowledge of provider billing and practices to the research accounts with credit balances.

Research and identify, the cause of credit balance(s) for various team functions such as: Curae Workqueue, Pre-Admit Workqueue, OMFS Workqueue, OB Workqueue, Hospital Credit Balance review, Unclaimed Property Returned Item Research etc.

Conduct timely review of outstanding balances, apply overpayment(s) and/or initiate the refund.

Analyze payments based on regulatory guidelines, ensuring administrative charges, coding and billing align to EOB (Explanation of Benefits) details, which includes, determining whether the payments were paid and posted correctly.

Take ownership of assigned workloads, to meet and/or exceed departmental metrics and standards, while supporting the reduction of A/R balances.
Engage Revenue Cycle Department as needed, to aid in accurate allocation of charges.
Responsible for review, correction, and resolution of all account credit balances.
Confirm accuracy of refund check detail to include demographic information and dollar amount as captured in the Accounts Payable system.

Qualifications:

Qualifications:

Experience Requirements:
- 2 years Medical Billing and/or Insurance Follow-Up - Preferred
- Understanding of basic insurance rules and explanation of benefits is essential - Preferred
- Customer Service skills - Preferred
- Payment posting optional - Preferred
- Knowledge of EPIC - Preferred