Payment Processor/Poster

Credit Specialist

Research patient and insurance credit balances from system work lists and request appropriate refunds. Efficiently process refund requests received from Insurance Companies and Responsible Parties. Authorize and process credit balances requested by staff within the organization subject to authorization maximum. Act as resource for billing office staff concerning credit balances.

Essential functions are the duties and responsibilities that are essential to the position (not a task list). o not include if less than 5% of work time is spent on this duty. Be specific without giving explicit instructions on how to perform the task. Do not include duties that are to be performed in the future. Duties should be action oriented and avoid vague or general statements.

Refund Processing

Ensure patient satisfaction through timely and effective processing of refund requests.

Respond to communication from third-party payors with requests for refunds.

Daily monitoring and resolution of credit balances via reports and/or correspondence, workques, patient, clinic phone calls or emails.

Review, audit, and process accounts in credit balance WQ's identifying accounts for which a refund is due.

Effectively authorize and process refund requests submitted by staff outside and within the department.

Submit inquiries to payers to request a recoup be performed.

Trace errors, record adjustments to proper accounts, and determine the appropriate destination for refunds due.

Resolve account discrepancies by auditing account detail.

Excellence in Patient Billing Using knowledge of payor guidelines for co-pays, deductibles, co-insurances, and out of pocket expenses to insure all patient or Third party responsibility is collected before any refunds are generated

Balance all refunds processed to ensure amounts equal to Accounts Payable total refunds amount for the week.

Follow all Federal, State and industry requirements of overpayment timelines

Completes special projects and monthly reports as assigned.

Demonstrate a professional image in dealing with the public, patients, families, and vendors.

Share responsibility through timely communication of identified problems to assure proper follow up is completed to expedite resolution of patient accounts issues.

Systems Competency

Demonstrate competency with all applicable software programs.

Performs other duties as assigned.

Basic UPH Performance Criteria

Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.

Demonstrates ability to meet business needs of department with regular, reliable attendance.

Employee maintains current licenses and/or certifications required for the position.

Practices and reflects knowledge of HIPAA, TJC, DNV, OSHA and other federal/state regulatory agencies guiding healthcare.

Completes all annual education and competency requirements within the calendar year.

Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of hospital administrative staff. Takes appropriate action on concerns reported by department staff related to compliance.

Minimum Requirements

Identify items that are minimally required to perform the essential functions of this position.

Preferred or Specialized

Not required to perform the essential functions of the position.

Education:

High school diploma or GED equivalent.

Experience:

General knowledge of bookkeeping, basic accounting, and familiarity with insurance industry practices.

General knowledge of CPT and ICD9 codes.

Strong analytical, organizational, and communication skills required.

Minimum of two years related work experience in a health care environment.

Demonstrated knowledge of managed care principles, insurance industry practices, and medical terminology required.

Excellent verbal and written communication skills necessary.

Ability to operate data entry equipment and related computer systems.

Typing skills of 40wpm.

Ability to concentrate and pay close attention to detail.

License(s)/Certification(s):

Valid driver's license when driving any vehicle for work-related reasons.

Knowledge/Skills/Abilities:

Writes, reads, comprehends and speaks fluent English

Basic computer knowledge using word processing, spreadsheet, email and web browser.

Other:

Use of usual and customary equipment used to perform essential functions of the position.

SCOPE: Position has supervisory responsibilities? Yes ?? or No ?? If yes, complete below.

Number of Employees Supervised (Complete if position has supervisory responsibilities of individuals)

Direct

Indirect

Total

Exempt

Non-Exempt

Total

Budget Control (Complete if position has budget responsibilities)

Annual Operating Budget (including payroll)

Annual Revenue/Sales

Other Scope Measurements

Pertinent to the position, such as number of beds, number of units/departments, number of employees leading, cases per month, etc.

Item

Number

Mental/Cognitive Demands:

(List any special mental and cognitive abilities required by the position in your specific environment)

Demonstrated knowledge of managed care principles, insurance industry practices, and medical terminology required.

Excellent verbal and written communication skills necessary.

Must be able to concentrate in a busy office, shared with other staff members.

Ability to operate data entry equipment and related computer systems.

Typing skills of 40wpm.

Ability to concentrate and pay close attention to detail.

WORKING CONDITIONS:

Physical Requirements

(Check all that apply if essential to perform job with or without accommodations)

??? Talk/Hear (communicate, detect, converse with, discern, convey, express oneself, exchange information)

??? See (defect, determine, perceive, identify, recognize, judge, observe, inspect, estimate, assess)

??? Stand or Sit (stationary position)

??? Walk (move, traverse)

??? Use hands/fingers to handle or feel (operate, activate, use, prepare, inspect, place, detect, position)

??? Climb (stairs/ladders) or Balance (ascent/descent, work stop, traverse)

??? Bend/Stoop/Kneel

??? Squat/Crouch/Crawl

??? Reaching/Twisting

??? Taste/Smell (detect, distinguish, determine)

??? Pushing/Pulling

Lifting Requirements

(Check appropriate category to perform job with or without accommodations)

??? Level 1; Sedentary Work: Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.

??? Level 2; Light Work: Exerting up to 20 pounds of force occasionally or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. Requires walking or standing to a significant degree, pushing or pulling arm or leg controls or maintaining a production rate pace. Light work requires physical exertion of forces greater than that of sedentary work.

??? Level 3; Medium Work: Exerting up to 50 pounds of force occasionally, and/or up to 20 pounds of force frequently, and/or up to 10 pounds of force constantly to move objects.

??? Level 4; Heavy Work: Exerting up to 100 pounds of force occasionally, and/or up to 50 pounds of force frequently, and/or up to 20 pounds of force constantly to move objects.

??? Level 5; Very Heavy Work: Exerting in excess of 100 pounds of forces occasionally, and/or in excess of 50 pounds of force constantly to move objects.