Credit Balance Specialist- BCBS

Credit Balance Resolution Analyst

The Credit Balance Resolution Analyst focuses on resolving credit balance issues. The Credit Balance Resolution Analyst reviews data to determine the corrective action needed and submits appropriate documentation to bring the account to resolution. Essential functions include determining if the payments received are correct and then determining the appropriate steps for resolution, including refund payment, transfer, and adjustment. The analyst reviews entire guarantor records to identify accounts across all facility locations with open patient responsibilities and transfers patient payments when appropriate. Key and import refunds and payment transfers accurately into the designated Patient Accounting system daily. Apply credit balance reconciliation changes and updates according to any internal or regulatory guidelines at the federal, state, and local levels. Coordinate and collaborate with Patient Accounting areas for proper information and communication when resolving credit balances. Verify and update insurance when necessary to assure correct contractual adjustment is applied. Effectively and accurately utilize the computer system to enter appropriate information. Reconcile refund entries on patient accounts to A/P checks processed; correct any errors and obtain proper authorization for any refund processed. Report trends and issues identified during account analysis to management for additional review and resolution; including those relating to payment posting, billing, payer reimbursement, and compliance. Maintain necessary logs and monthly performance standards to assure department goals are met. Maintain reasonably regular, punctual attendance consistent with policies, the ADA, FMLA and other federal, state and local standards. Maintain compliance with all policies and procedures.