Credit Balance Analyst | Refunds Department

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.

• 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 over payment(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
:

• 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
• Education:
• High School Diploma or GED equivalent - Required
• Additional Duties:
• Additional duties as assigned may vary.

UFJPI is an Equal Opportunity Employer and a Drug-Free Workplace.