Credit Balance Resolution Specialist

Job Title:

Credit Balance Resolution Specialist

Reports To:

Senior Manager, Patient Account Services FLSA Status:
Non-exempt Summary of Position:

The Credit Balance Resolution Specialist is responsible for evaluating all accounts with credit balances and performing processes needed to resolve them.

• Employee must adhere to STRG Policies and Procedures at all times
• Evaluate accounts with credit balances and perform processes needed to resolve them, including researching if the balance is actually owed and who it is owed to
• Evaluate refund requests from various payors and determine proper action
• Transfer payments
• Work Task Management Queues in Groupcast ensuring that records are worked within five days of original entry date
• Work refund requests (manuals) as assigned within seven days of receipt
• Demonstrate complete knowledge of computer system with regard to refund menu
• Take other steps to move account balances to resolution (e.g. set to bill to patient)
• Maintain confidentiality of patient protected health information (PHI) as mandated by STRG procedures and HIPAA Privacy, Security, & HITECH regulations
• Track and record credit balance resolution production in time analysis
• Perform other tasks as directed
• Maintain strict confidentiality of patient protected health information (PHI) as mandated by STRG procedures and HIPAA Privacy, Security, and HITECH regulations
• Perform other duties as required
• Counting Production:
  • Auto refunds:
    Count each charge that has a credit balance that is resolved as the result of the work being done. The following tasks are included in the time required to resolve a charge: checking for other related accounts; checking for small balance write-offs; letter to patient or insurance regarding the refund; completing the Payment Processing error log; entering refund info into the BCBS ERM;
    
    verifying allowed; verifying MPPR or MSR; adjustment to other charges/ accounts; checking for open charges on the account; completing the Credit Balance Worksheet
  • Manual refunds:
    Most charges for which a refund request is received will not show a credit balance. When working refund requests, count as a charge worked any charge that is reviewed, for which an adjustment or transfer is requested, or which is being error corrected to another insurance payor. The following tasks are included in the time required to resolve a charge:
    Pull required documents; review EOBS; calculate MPPR or MSR; review for SB418; complete document for request EC; complete credit balance worksheet; check fee schedules; check for open charges on account; complete credit balance worksheet

None

One to two years’ general office experience. Medical insurance or AR experience is a plus.

High School diploma or GED

Maintaining and satisfying minimum attendance requirements is an essential function of this position, including working all full-time regular hours as established for this position and scheduled or emergency overtime. Full-time regular hours are defined as Monday through Friday, with after-hours or weekends as required. All employees in this job classification are required to satisfy this requirement. This job classification does not include "light duty" work or allow unpredictable or unrestricted absences.