Credit Balance Review Specialist

About Us

We are Emerus, the leader in small-format hospitals. We partner with respected and like-minded health systems who share our mission: To provide the care patients need, in the neighborhoods they live, by teams they trust. Our growing number of amazing partners includes Allegheny Health Network, Ascension, Baptist Health System, Baylor Scott & White Health, ChristianaCare, Dignity Health St. Rose Dominican, The Hospitals of Providence, INTEGRIS Health, MultiCare and WellSpan. Our innovative hospitals are fully accredited and provide highly individualized care. Emerus' commitment to patient care extends far beyond the confines of societal norms. We believe that every individual who walks through our doors deserves compassionate, comprehensive care, regardless of their background, identity, or circumstances. We are committed to fostering a work environment focused on teamwork that celebrates diversity, promotes equity and ensures equal access to information, development and opportunity for all of our Healthcare Pros.

Position Overview

The Credit Balance Review Specialist is primarily responsible for monitoring and resolving credit activity that is housed in the patient accounting system as well as refund request letters received from governmental and commercial carriers. The Credit Balance Review Specialist will review the patient’s account to include; charges, accuracy of reimbursement to expected reimbursement and how that payment was posted to the billing system to determine if a true credit exits. If a refund is required, the Credit Balance Review Specialist will complete the appropriate refund form. The Credit Balance Review Specialist will identify trends that exist, the root cause for credits, and collaborates with the appropriate parties to minimize refunds. The Credit Balance Review Specialist reports to the Patient Account Manager.

Essential Job Functions

• Research credit balances on patient accounts
• Determine the correct course of action to resolve the refund request or credit balance which could include but not limited to:
  • Accurate completion of refund request for submission to refund department.
  • Requesting payment corrections or adjustment corrections as needed.
  • Requesting transfer of patient payments to other patient accounts that have patient balances that may reside in patient accounting system.
• Work closely with third-party payors throughout the refund and credit issue resolution process.
• Maintain knowledge of insurance payments and rejection/denial processes.
• Update credit balance/refund reports as necessary
• Notify payor representative to initiate takeback (recoupment) and provides support documentation as required to the payor representative.
• Provides all required documentation necessary for refund approval.
• Submits validated refund request documents for Lead review and approval.
• Ensures complete, accurate, and timely account notation and documentation in the patient accounting system, including adjudication and denial processing.
• Works closely with the Team Leads of the CBO

Other Job Functions

• Attend staff meetings or other company sponsored or mandated meetings as required
• Perform additional duties as assigned

Basic Qualifications

• High School diploma or GEC equivalent, required
• 2+ years prior related Healthcare Facility Revenue Cycle experience, preferably with credit balance resolution, required
• Experience in account inquiries and analysis to investigate and evaluate the payment methodology and accuracy, required
• Clear understanding of contract terms, payer policy, and strong understanding of explanation of benefits.
• Excellent written, verbal communication and interpersonal skills.
• Ability to work independently, prioritize work and results oriented.
• Must possess a strong math aptitude.
• A demonstrated ability to use office productivity tools such as Microsoft Outlook, Word, and general computer skills necessary to work effectively in an office environment.
• A demonstrated ability to use Microsoft Excel to download reports and manipulate data using formulas and pivot tables.