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Location:Service Center, Omaha NE
Position Type: Regular
Scheduled Hours per 2 week Pay Period:80
Primary Location:NE > OMAHA > SERVICE CENTER-NORTH BLDG
Credit Balance Refund Rep:will support Bismarck market
JOB SUMMARY / PURPOSE
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
1. 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.
2. Refunds overpayments on accounts and transfers payments to the appropriate accounts.
3. Verifies all patient account charges are billed to the insurance plan.
4. Validates that insurance has paid correctly and identifies any patient responsibility.
5. Conducts appropriate review to accurately transfer payments in accordance with established procedures.
6. Proactively identifies, researches and resolves (with position scope) unusual, complex or escalated issues, as necessary.
7. Notifies Supervisor/Manager of ongoing issues and concerns.
8. Documents all activities and findings in accordance with established policies and procedures; ensures the integrity of all account documentation; maintains confidentiality of medical records.
9. Adheres to refund approval protocols for non-routine refunds.
10. 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.
Required Licensure and Certifications
Does Not Apply
Required Minimum Knowledge, Skills and Abilities
Knowledge of basic medical terminology, abbreviations, CPT and ICD codes, compliance, HIPAA, government and other regulations and medical insurances, and payer contracts.
Knowledge of general office principles, practices, standards, systems and tools/equipment and the operation and application of automated systems applicable to the assigned function.
Ability to enter data in accordance with established standards of timeliness, accuracy and productivity, apply detailed billing requirements and insurance follow-up practices.
Ability to keep abreast of trends, developments and changing regulatory requirements, troubleshoot, identify and articulate non-compliance with established guidelines and/or regulatory requirements that impact matters within designated scope of responsibility.
Ability to demonstrate attention to detail, critical thinking skills, and make decisions based on available information and within the scope of authority of the position and within the context of the assigned functions, effectively prioritize and execute tasks while under pressure with a commitment to accuracy.
Ability to demonstrate excellent customer service skills, including professional telephone interaction, maintain confidentiality of medical records and to use discretion with confidential data and sensitive information.
Ability to establish and maintain effective working relationships as required by the duties of the position.
Ability to use office equipment and automated systems/applications/software at an acceptable level of proficiency.
Three years of revenue cycle or related work experience that demonstrates attainment of the requisite job knowledge and abilities preferred.
Graduation from a post-high school program in medical billing or other business-related field is preferred.
High School Diploma or GED preferred.
Requisition ID: 2020-R0285131
Shift: Day Job
Market: CHI Health
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