Job Description
Bargaining Unit: EA Rate of Pay: $28.46/hour + DOE
Summary Analyzes denials and credit balances for determination of appeal possibilities, refund, or adjustment to the patient’s account. Determines what will be necessary to secure the missing payment and/or address the credit on the patients account. Provides reporting from multiple systems for multiple clients. Works on EPIC and/or other systems to identify back up and documentation that can be used to appeal and/or to support resolution of credit balances. Forwards accounts needing appeal to the appropriate staff for completion.
Essential Duties And Responsibilities - Identifies refunds utilizing all tools and department systems available.
- Researches denied accounts based on rejection (Claims Adjustment Reason Codes -CARC) presented on 3rd party payer remittance advices.
- Sorts denials based on resolution requirements.
- Bills voided or Corrected claims to payers as needed in order to initiate appropriate takebacks or credit balance correction.
- Distributes denials to the appropriate staff to create Denial letter and/or web-portal requests for reconsideration and/or appeals.
- Researches and resolves all credits on patient accounts by determining if balance is an error such as incorrect contractual allowance, or a true balance due to some party.
- Generates refunds when valid payer requests are received with back up and documentation.
- Processes both patient and third party payer refunds on patient accounts accurately and on a timely basis.
- Generates and sends patient refunds within thirty (30) days of the overpayment.
- Completes processing of refunds through the hospital information systems.
- Recalculates initial contractual posted adjustment and corrects errors made to a patient’s account.
- Compiles a log with the originating cause of the refund, and reports recurring issues to management.
- Runs ad hoc and scheduled reports for management and for outside services, including but not limited to quarterly Medicare and Medicaid credit balance report for all entities and HELP Financial updates.
- Assists with on-site credit balance reviews by payers and in-house auditors.
- Posts charges and/or adjustments to all systems as needed including post-audit adjustments.
- Researches and resolves unapplied payments in the undistributed account.
- Documents all activities via mail, e-mail, telephone, written correspondence or in person into the patient’s account.
- Cross-trains in other related business office functions to ensure smooth operation of the department.
- Communicates with the finance department, as necessary regarding General Ledger accounts to resolve all cash-related issues
- Works with PFS Clerk to ensure patient refund checks are mailed timely with appropriate documentation
- Processes returned refund checks as needed, calling to obtain updated address if needed to ensure proper delivery
- Maintains confidentiality of all protected health information (PHI).
- Other duties as may be assigned.
- Demonstrates System Values in performance and behavior.
- Complies with System policies and procedures.
Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Supervisory Responsibilities No supervisory responsibilities.
Minimum Education/Experience Certificate of completion from college or vocational school or 1-2 years relevant experience
Required Licenses/Certifications None
Other Experience/Qualifications Required:
- A minimum of one year of experience using Microsoft office, with focus on WORD and Excel knowledge.
- Detailed analysis and critical thinking.
Preferred:
- Three years of billing experience or healthcare financial related experience
Job Tags
Work at office,