Sr. Patient Account Specialist - Credit Balance

About Us

We are Emerus, the leader in small-format hospitals. We partner with respected and like-minded health systems who share our mission: To provide the care patients need, in the neighborhoods they live, by teams they trust. Our growing number of amazing partners includes Allegheny Health Network, Ascension, Baptist Health System, Baylor Scott & White Health, ChristianaCare, Dignity Health St. Rose Dominican, The Hospitals of Providence, INTEGRIS Health, MultiCare and WellSpan. Our innovative hospitals are fully accredited and provide highly individualized care. Emerus' commitment to patient care extends far beyond the confines of societal norms. We believe that every individual who walks through our doors deserves compassionate, comprehensive care, regardless of their background, identity, or circumstances. We are committed to fostering a work environment focused on teamwork that celebrates diversity, promotes equity and ensures equal access to information, development and opportunity for all of our Healthcare Pros.

Position Overview

The purpose of this position is to assist the Patient Account Supervisor in working with patients and third-party payers regarding payments made to patient visits. The position handles a specific group of accounts (credit balance and requests for refunds) and ensures timely and accurate resolution. This position is responsible for resolving third party payer and patient overpays or requests for refunds. This involves researching insurance benefits, understanding coordination of benefits between payers, distributing/reapplying or transferring payments to the appropriate date of service or account, generating refund requests, overpayment notifications or denying refund request according to guidelines. Accurate and timely resolution of overpays and requests for refunds is based on a knowledge and understanding of contractual obligations as well as regulatory requirements. This position is expected to work alongside staff as well as provide direction to less experienced staff in conjunction with the Patient Account Supervisor.

Essential Job Functions

• Assists in assigning staff workloads and shifts priorities as necessary.
• Monitor activities performed by Credit Balance team to make sure that credit balances and requests for refunds are reconciled appropriately and timely.
• Routinely communicate with payers regarding overpayments, request recoupment, void claims with payer if necessary
• Conduct timely and accurate review of overpayments, credit balances and request for refunds.
• Responsible for reviewing, validating, and correcting adjustments on accounts based on insurance reimbursement and coverage, contracted payers and services provided.
• Validate and update patient demographic and insurance to ensure accuracy of future claims.
• Initiate refunds to patients/guarantors, insurance companies, and other third parties by following established refund procedures, contractual obligations, payer and regulatory requirements.
• Utilize on-line/telephonic resources to verify benefits and ensure claims are processed according to the appropriate benefit levels.
• Assists in the review of refund request for accuracy and submits as necessary
• Assists in the review of adjustment requests for accuracy and submits as necessary
• Assists in the development and training of workflow process for staff and as deemed necessary for payer behavior responses
• Works special projects and provides ad hoc review of claims as assigned by Supervisor/Director/CFO
• Works closely with CBO intra departments to ensure resolution of pending claim activities.

Other Job Functions

• Meet position’s goals and objectives related to accuracy and productivity (e.g. days in AR, cash collections, etc.)
• Attend staff meetings or other company sponsored or mandated meetings as required
• Perform additional duties as assigned

Basic Qualifications

• High School Diploma or GED, required
• 3+ years relevant experience in a provider inpatient or outpatient setting, required
• Requires advanced knowledge of claims processing, appeals, medical terminology, accounts receivable, claim forms, claims billing, insurance verification, adjustments and refunds, claims status, and reimbursement
• 2+ years previous Team Leader/Supervisory experience or equivalent , required
• Advanced knowledge of all payer insurance groups, including a Medicare, Medicaid and government managed care experience, is required
• Previous coaching and or training experience and the ability to create training manuals and training tools and materials, preferred
• Experience with medical records or patient accounting systems, required
• Knowledge and understanding of state and Federal payment laws to ensure prompt and accurate reimbursement, required
• Advanced knowledge and understanding of healthcare ‘explanation of benefits’ (EOB’s), required
• Intermediate knowledge of Microsoft Office products (Outlook, Excel, Word). Excel experience should include (vlookup/xlookup, pivot tables, basic formulas), required
• Position requires fluency in English; written and oral communication