Credit Balance Refund Rep - #604177
CHI Health Clinic
Date: 11/25/2021 22:00 PM
City: Omaha, Nebraska
Salary: $35,443 - $53,164 / year
Contract type: Full Time
Work schedule: Full Day
CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. & from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.
REMOTE WORK OPPORTUNITY
This job is responsible for facilitating the resolution of insurance and patient credit balances and issuing/requesting refunds, immediate offsets and/or redeterminations as appropriate for patient satisfaction and compliance with applicable regulations. Work includes responsibility for the timely and accurate resolution of all credit balance accounts and any action on accounts that result in unapplied activity
An incumbent researches accounts to determine whether: 1) a refund is appropriate to either the patient or the insurance company; 2) a payment transfer is needed; or 3) a reversal of contractual allowance or administrative adjustment is warranted
Work requires an understanding of detailed billing requirements and insurance follow-up practices, as well as attention to detail, and the ability to accurately and timely troubleshoot/resolve (within scope of the position) resolution of refunds issues.
ESSENTIAL KEY JOB RESPONSIBILITIES
- Reviews accounts and/or reports, including: Explanation of Benefits (EOB)/ Electronic Remittance Advice (ERAs), payments, adjustments, insurance contracts and contracting system, insurance benefits, and all account comments; contacts and communicates with insurance companies to gather additional information, as necessary.
- Refunds overpayments on accounts and transfers payments to the appropriate accounts.
- Verifies all patient account charges are billed to the insurance plan.
- Validates that insurance has paid correctly and identifies any patient responsibility.
- Conducts appropriate review to accurately transfer payments in accordance with established procedures.
- Proactively identifies, researches and resolves (with position scope) unusual, complex or escalated issues, as necessary.
- Notifies Supervisor/Manager of ongoing issues and concerns.
- Documents all activities and findings in accordance with established policies and procedures; ensures the integrity of all account documentation; maintains confidentiality of medical records.
- Adheres to refund approval protocols for non-routine refunds.
- Meets quality assurance and productivity standards through identification, reconciliation of credit balance accounts and review of credit balance reports for potential overpayments in accordance with organizational policies and procedures.
- Knowledge of basic medical terminology, abbreviations, CPT and ICD codes, compliance, HIPAA, government and other regulations and medical insurances, and payer contracts.
- Three years of revenue cycle or related work experience that demonstrates attainment of the requisite job knowledge and abilities preferred.
A compensation range of $35,443 - $53,164 is the reasonable estimate that CommonSpirit in good faith believes it might pay for this particular job based on the circumstances at the time of posting. CommonSpirit may ultimately pay more or less than the posted range as permitted by law.