Job Purpose:
The Credit Balance Resolution Representative is responsible for working with patients and third-party payers regarding payments made to professional and hospital accounts. The position handles a specific group of accounts (credit balance, undistributed payments, and requests for refunds) and ensures timely and accurate resolution. The position is responsible for working with internal and external customers (e.g., third party payers, patients/guarantors, estate representatives, attorneys, employers,) to facilitate the prompt resolution of credit balances or requests for refunds.
This position is responsible for resolving accounts with credit balances which include insurance and patient overpayments, undistributed payments, and 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/provider or account, and updating
account adjustments, generating refund requests, overpayment notifications or denying refund request according to
guidelines. Accurate and timely resolution of overpays, undistributed payments and requests for refunds is based on a
knowledge and understanding of contractual obligations as well as regulatory requirements.
Essential Duties & Responsibilities:
- Responsible for credit balances, undistributed payments and requests for refunds
- Conducts timely and accurate review of undistributed payments, overpayments, credits and requests for refunds in the patient accounting system
- Responsible for taking all steps necessary to facilitate prompt and accurate resolution of payments including follow up with third party payers to determine coordination of benefits, insurance primacy rules and filing order.
- Effectively communicate information about insurance billing and follow-up processes to patients and internal customers
- Initiate refunds to patients/guarantors, insurance companies, and other third parties by following established refund procedures, contractual obligations, payer and regulatory requirements.
- Conduct timely and accurate review of refund requests for payers with contracted recoupment language to reduce future recoupment reconciliations.
- Analyze data, identify issues, reach conclusions, and propose strategies for resolution of complex reimbursement issues.
- Determine the most effective repayment method based on payor processes, i.e. Manual Refund via Check, Resubmission of corrected claim, Payor Offset.
- Responsible for reviewing, validating, and correcting adjustments on accounts based on insurance reimbursement and coverage, contracted payers, and services provided.
- Redistribute and/or transfer payments between multiple accounts of the same patient within the patient accounting system.
- Validate and update patient demographic and insurance information to ensure accuracy of future claims.
- Reconcile misdirected and clearing accounts by researching and posting payments to the correct accounts.
Internal Responsibilities:
- Adheres to all company policies and procedures including, but not limited to those identified within the Standards of Business Conduct and the Employee Handbook, as may be amended from time to time. Adheres to all applicable laws and regulations and the company's governance/compliance program.
- Responsible for reporting violations of the company's policies and procedures, Standards of Business Conduct, governance program, laws and regulations through the company's Help Line or other mechanism that may be available at the time of the violation. Assists with internal control failure remediation efforts.
- Becomes knowledgeable of internal control responsibilities through training and instruction. Responsible and accountable for internal control performance within their area of responsibility. Participates in the internal controls self-assessment process.
- Ensures concerns with internal control design or performance and process changes that impact internal control execution are communicated to management.
Minimum Qualifications & Competencies:
- 3 years’ experience in healthcare customer service or insurance collections field.
- 1 year working Credit Balance and Underpayments for Insurance and Patient Balances
- Strong knowledge of computer billing systems.
- Experience working with customer support/client issue resolution management.
- Proficiency with MS Office
- Excellent oral and written communication skills.
Preferred Qualifications & Competencies:
- Utilization and understanding contract management systems
- Utilization and understanding Hard Copy Payor Contracts, specifically payment metrics including fee schedules, and outliers
- Understanding of State regulations regarding hospital credit balances for Insurance Companies and Patients
Job/Functional Knowledge
Understands duties and responsibilities, has necessary functional and technical knowledge for task completion, keeps job knowledge current, applies knowledge and skills that lead to success in the job.
- Effectively applies background & experience to current role
- Demonstrates a comprehensive knowledge of particular field.
- Keeps informed of latest trends, developments, and best and current practices in particular field
Culture Fit
Demonstrates integrity and ethics in day-to-day tasks and decision making, adheres to Savista’s core values of compassion, commitment, character, and confidence, operates effectively in the Savista environment and the environment of the work group, maintains a focus on self-development and seeks out continuous feedback and learning opportunities.
- Exhibits integrity in all actions and communication
- Works well autonomously, while acting as a team-player
- Demonstrates a vested interest in self-development
Travel: N/A
Note: Savista is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $17.00 to $20.00. However, specific compensation for the role will vary within the above range based on many factors including but not limited to geographic location, candidate experience, applicable certifications, and skills
