Refund and Credit Balance Specialist
About The Position
The Refund and Credit Balance Specialist, also known as the Senior Government Credit Balance Specialist (SGCBS), resolves accounts with credit balances, including credits associated with audit findings and overpayments or overadjustments by payors and patients. The specialist reviews payor refund requests and coordinates rebilling to the primary payor according to departmental guidelines. The role also involves collecting on accounts refunded by the Medical Center and payment retractions generated by payors, reviewing external auditor refund requests for management approval, resolving credits to meet payor quarterly and annual credit balance reporting requirements, and cancelling or adjusting previous claims submissions. The specialist uses multiple databases and applications to analyze information and documents and determine appropriate action. The role requires frequent contact with Patient Financial Services staff, departments and management, patients, and billing, professional-fee, and collection-services vendors.
Requirements
- High school diploma or GED and five years of experience, including two years of collections investigation experience, or an equivalent combination of education and experience.
- Knowledge of contracts, insurance billing requirements, UB04 claim forms, Medicare, Medi-Cal, and compliance program regulations.
- Good analytical and organizational skills, and interpersonal, verbal, and written communication skills.
- Knowledge of computer operation, keyboard functions, calculator, copier, and fax machine operation.
- Adequate keyboard skills.
- Proactive and assertive account resolution skills.
- Motivation, a positive attitude, and exceptional work ethics.
- Ability to follow directions and written procedures.
- Ability to balance assertiveness with compassion for patients and others.
- Thorough understanding of CPT, ICD, DRG, and HCPC codes.
- Thorough understanding of stop losses, per diems, carve outs, and other contract terms and conditions.
- Computer software skills, including Microsoft applications and email.
- Ability to work in Emeryville when required.
- For internal applicants only: demonstrate an in-depth understanding of all aspects of billing greater than an Office Assistant III and Senior Collections Rep I.
Nice To Haves
- Medical terminology experience.
- Understanding of HIPAA rules and regulations.
Responsibilities
- Resolve accounts with credit balances, including credits associated with audit findings and payor or patient overpayments and overadjustments.
- Review payor refund requests and coordinate rebilling to the primary payor in accordance with departmental guidelines.
- Collect on accounts refunded by the Medical Center and payment retractions generated by payors.
- Review external auditor refund requests for management approval.
- Resolve credits in accordance with payor quarterly and annual credit balance reporting requirements.
- Cancel or adjust previous claims submissions.
- Use multiple databases and applications to analyze information and documents and take appropriate action.
- Maintain frequent contact with Patient Financial Services staff, departments and management, patients, and billing, professional-fee, and collection-services vendors.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
High school or GED
