Credit Balance Specialist - Healthcare Hospital Claims

Guidehouse•San Antonio, TX

3d•Hybrid

About The Position

The Credit Balance Specialist (Hospital Claims) will manage credit balance workloads of patients and respond/follow-up on external and internal inquiries in a timely manner. This person should have a solid understanding of the Revenue Cycle as it relates to the entire life of a patient account from creation to payment. Individuals must be able to work an eight hour shift between the hours of 8:30 AM CT - 5:30 PM CT, with no remote work initially BUT an opportunity for some hybrid (in office/remote) schedules after training. We will consider individuals open to relocation to San Antonio! Additionally, the Credit Balance Specialist will: Research and resolve patient credit balance accounts resulting from overpayments, duplicate payments, financial assistance adjustments, or insurance reprocessing. Analyze overpayments, duplicate payments, coordination of benefits (COB), retro eligibility, and contractual adjustment discrepancies. Collaborate with billing, cash posting, denial management, and patient access teams to resolve account discrepancies. Process patient refunds accurately and timely in accordance with client policies and regulatory requirements. Communicate with patients regarding refund status, account balances, and payment discrepancies professionally and compassionately. Maintain accurate, clear, concise and complete account notes and other relevant information. Resolve unidentified payments through research. Aim to have patient accounts balance to zero prior to accounts being forwarded to an outside agency for collections. Assist with internal and external audits related to credit balance processes and refund activity.

Requirements

High School Diploma / GED.
1+ years of working with credit balance accounts (refund, overpayment, underpayment, accounts resolution, etc.)
Working knowledge of the following: health insurance claims, medical billing, medical coding, credit finance, accounting or customer service-related responsibilities

Nice To Haves

Credit balance experience within a hospital background
Experience working within Epic, Meditech or other hospital patient accounting systems.
Ability to interpret UB-04 claims, payer correspondence, and contractual agreements.
Basic knowledge of Commercial, Managed Care, Medicare and Medicaid insurance
PC skills in a Windows environment.
Knowledge and utilization of desktop applications to include Word and Excel.
Ability to initiate and follow through on projects and work independently with minimal supervision.

Responsibilities

Research and resolve patient credit balance accounts resulting from overpayments, duplicate payments, financial assistance adjustments, or insurance reprocessing.
Analyze overpayments, duplicate payments, coordination of benefits (COB), retro eligibility, and contractual adjustment discrepancies.
Collaborate with billing, cash posting, denial management, and patient access teams to resolve account discrepancies.
Process patient refunds accurately and timely in accordance with client policies and regulatory requirements.
Communicate with patients regarding refund status, account balances, and payment discrepancies professionally and compassionately.
Maintain accurate, clear, concise and complete account notes and other relevant information.
Resolve unidentified payments through research.
Aim to have patient accounts balance to zero prior to accounts being forwarded to an outside agency for collections.
Assist with internal and external audits related to credit balance processes and refund activity.

Benefits

Medical, Rx, Dental & Vision Insurance
Personal and Family Sick Time & Company Paid Holidays
Position may be eligible for a discretionary variable incentive bonus
Parental Leave
401(k) Retirement Plan
Basic Life & Supplemental Life
Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
Short-Term & Long-Term Disability
Tuition Reimbursement, Personal Development & Learning Opportunities
Skills Development & Certifications
Employee Referral Program
Corporate Sponsored Events & Community Outreach
Emergency Back-Up Childcare Program