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ECU Health · 5 days ago

Credit Balance Resolution Specialist

Greenville, NC

Full-time

Onsite

Mid Level

3+ years exp

ECU Health is a mission-driven academic health care system serving over 1.4 million people in eastern North Carolina. The Credit Balance Resolution Specialist is responsible for researching and resolving patient accounts with credit balances, validating third party payer refund requests, and preparing governmental credit balance reports.

Hospital & Health Care

Responsibilities

Research and resolve patient accounts with credit balances

Validate and process third party payer refund requests

Compiles and submits quarterly governmental credit balance reports

Stays current on rules and regulations affecting billing, reimbursement and submission of claims

Process correspondence received from third party payers and patients

Performs other related responsibilities as required or requested

Demonstrates service excellence

Review and research patient accounts with credit balances. Contact third party payers, employers, state agencies and patients to help determine resolution. Evaluate documentation for posting or payment discrepancies. Initiate a refund or validate a corrected claim using billing software based on payer regulations and departmental policies and procedures. Recognizes and reports trends and potential problems with billing and posting issues that creates credit balances. Documents all actions taken

Validate all requests from third party payers for refund, ensuring they are legitimate in accordance to our contractual obligations and meet governmental requirements. Initiate refund within required timeframe. Documents all actions taken

Review credit balance data to identify accounts qualifying for the quarterly Medicare and Medicaid Credit Balance Report. Prepare reports as required by CMS and DMA regulations. Follow up with agencies to ensure the reports are received by the required due dates. Documents all actions taken

Reviews payer bulletins and websites for changes in rules and regulations. Interprets and incorporates changes into billing and collection activities. Attends educational seminars and meetings

Responds to all requests for documents required for timely claim resolution and prompt patient customer service

Performs in accordance with accepted procedure and responds to special requests by management in a timely and accurate manner

Adheres to the policies and procedures. Uses tact and courtesy in all interactions including but not limited to staff, patients and payers. Promotes a positive image and supports management in goals and objectives. Handles inquiries and complaints discreetly and effectively

Qualification

Reimbursement knowledgeBilling experienceFinancial reportingPatient accountingInsurance claims researchCustomer serviceAttention to detailCommunication skills

Required

High School plus 2 years or more of formal training or education. Specify: Business or related

3 to 4 years experience. Reimbursement and/or billing knowledge, knowledge of financial reporting, experience researching unpaid and denied insurance claims, familiarity with secondary billing, appeals, and contractual adjustments. Patient Accounting, Insurance or Cash Applications. Previous experience in a physician or hospital business/billing office working with insurance companies

One year of related experience may be substituted for one year of education up to two years