Credit Balance Analyst; Patient Accounting

Job Description

Credit Balance Analyst (Patient Accounting) (2600005U)

Responsible for timely research and resolution of insurance credit balances on highly complex cases. Performs necessary functions to refund over payments from insurance carriers within 30 days of receipt. Manages work queues related to insurance over payments and credit balances, identifies trends, potential resolutions, and escalates to management. Evaluates accuracy of contract modeling, communicates findings, and escalates as appropriate. Reports state Medicaid's credit balances on a quarterly basis, participates in payer meetings to resolve issues, and ensures solutions are implemented and goals achieved.

Identifies and monitors CMS and payer rule changes to ensure compliance.

• Ensure all assigned claims and encounters are reviewed in a timely manner per SOP.
• Evaluate contract management expected reimbursement and report discrepancies per guidelines.
• Assess over payments and process timely per procedures.
• Rebill claim or issue refund to facilitate payment retraction or refund.
• Establish a system to ensure refund requests from insurance carriers are processed within 30 days of receipt.
• Read and interpret payer contracts for accuracy when submitting refund requests for approval.
• Ensure appropriate supporting documentation is included with refunds.
• Report state Medicaid’s credit balances on a quarterly basis.

• Manage matrix of issues and resolutions, including accountable stakeholders; ensure results and escalation; report updates to manager.
• Conduct root cause analysis of issues affecting over payments, identify key issues, and assist in tracking, trending, and reporting.
• Present data and analysis clearly to all levels of staff and management.
• Meet with manager and outside departments to review issues and develop action plans.
• Assist in development of solutions, training, and education guidelines to resolve issues and share data with staff and management.
• Appropriately engage and involve key accountable stakeholders in a collaborative manner.
• Research payer and CMS policies related to revenue cycle, identify and alert stakeholders of required changes, and track completion.

• Track Refunds: maintain a refund request log to monitor the request, issuance, mailing, and posting of refunds; provide supporting documentation to Accounts Payable with completed signatures and backup.
• Organizational Commitment/Identification: partner in the mission and uphold core principles, demonstrate commitment to diversity, exhibit personal and professional integrity, and maintain confidentiality at all times.
• Customer Service: anticipate and respond to customer needs; follow up until needs are met.
• Teamwork/Communication: demonstrate collaborative and respectful behavior, partner with all team members to achieve goals, and remain receptive to others’ ideas and opinions.
• Performance Improvement/Problem‑solving: contribute to a positive work environment, demonstrate flexibility and willingness to change, identify opportunities to improve clinical and administrative processes, and make appropriate decisions using sound judgment.
• Cost Management/Financial Responsibility: use resources efficiently and search for less costly ways of doing things.
• Safety: speak up when team members exhibit unsafe behavior or performance, continuously validate and verify information needed for decision making or documentation, stop in the face of uncertainty and take time to resolve, demonstrate accurate, clear, and timely communication, actively promote safety for patients, families, visitors, and co‑workers, and attend to important details by practicing Stop, Think, Act, and Review to self‑check behavior and performance.

• Minimum Education: Bachelor's Degree (Preferred)
• Minimum
  
  Work Experience:
  
  3 years related patient accounting experience, especially with insurance over payments trending and root cause analysis.
• Required Skills/Knowledge: Excellent working knowledge of complex contract reimbursement methodologies (e.g., transplant, global, APR DRGs); proven analytical skills; advanced PC skills in…