About this role
The Refund and Credit Balance Specialist also known as our Senior Government Credit Balance Specialist (SGCBS), is responsible for resolving accounts with credit balances. These include credits associated with audit findings and overpayments/overadjustments by payors and patients. Additionally, the SGCBS reviews requests for refunds from payors and coordinates the rebilling process to the primary payor following departmental guidelines. The SGCBS is also responsible for the following but not limited to:
- Collections of accounts refunded by the Medical Center and payment retractions generated by the payor.
- Reviewing external auditor refund requests for management approval
- Resolving credits by meeting payor quarterly/annual credit balance report requirements and;
- Cancelling or adjusting previous claims submissions.
The SGCBS utilizes multiple databases and applications to analyze and take appropriate action on information or documents received. Applications and Databases consist of EPIC, Hospital Rates, CIRIUS, RevCyclePro, Imaging, Refund Database, DDE and various payer websites. Frequent contact with Patient Financial Services staff, departments and management, as well as patients, billing and professional fee and collection services vendors.
- Cancelling or adjusting previous claims submissions.
Requirements
- High School diploma or a GED and five years of experience, including two years of experience in collections investigation; 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, 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.
- Must be a motivated individual with a positive and exceptional work ethics.
- Ability to follow directions and written procedures.
- Ability to balance assertiveness with compassion for the patient and others.
- Must have a thorough understanding of CPT, ICD, DRG, and HCPC codes.
- Must have a thorough understanding of stop losses, per diems, carve outs and other contract terms and conditions.
- Computer software skills (i.e. Microsoft Applications and E-mail, etc.).
- The ability to work in Emeryville when required.
- This requirement is applicable to Internal applicants only: Must demonstrate an in-depth understanding of all aspects of billing greater than an Office Assistant III and Senior Collections Rep I.
Preferences
- Medical terminology experience.
- Understanding of HIPAA rules and regulations