Credit and Refund Representative I - York - Days

Full time (40 hours weekly)
Monday-Friday 7:00a-3:30pm. Hours can be changed after probationary period

General Summary

Provides prompt, efficient and accurate resolution of all Hospital and Professional Billing insurance credits in accordance with established policies and procedures. Researches payor policies regarding refund/overpayment guidelines.

Duties and Responsibilities

Essential Functions:

• Accesses credit balance work queues daily to ensure accurate and timely follow up and resolution of accounts with credit balances.
• Performs various functions within the credit balance AR including but not limited to insurance refund and adjustment requests.
• Investigates historical data for each account for potential refund of credit.
• Researches hospital transaction activity and accesses detailed remit data to determine appropriate account resolution.
• Interacts with the appropriate Teams to determine proper account resolution.
• Researches Medicare and Medicaid accounts for inclusion on the Medicare and Medicaid quarterly credit balance reports. Completes Medicare and Medicaid quarterly credit balance reports.
• Researches payor policies and contracts applies payor guidelines for refunding overpayments, including small balance write offs.
• Refunds insurance payers as necessary to resolve credits within billing system.
• Assists Supervisor or Manager with training new staff, as needed.
• May assist with daily huddles and maintain daily huddle board.
• Assists with creating and maintaining Standard of Work Documents for the department.
• Reviews and processes NSF and other financial information relayed from the Finance Team.
• Maintains knowledge of Legacy and Third-party systems needed to process refunds and transfer outstanding balances between such systems.
• Completes payment research request for payments not posted or accounted for in Epic or legacy systems.
• Assists Supervisor or Manager in compiling of root cause analysis and credit trending reports.
• Partners with other areas within the Revenue Cycle to provide feedback and remediation steps for credits reviewed to prevent them from happening in the future.
• Maintains knowledge of current and federal and state regulations pertaining to credits, refunds, and collections.

Common Expectations:

• Assists with correspondence, reports, filing, etc. as needed.
• Maintains appropriate records, reports, and files as required by department, organization State and Federal regulations.
• Maintains established policies and procedures, objectives, quality assessment, safety, environmental and infection control standards.
• Participates in educational programs and in-service meetings.
• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.

Qualifications

Minimum Education:

• High School Diploma or GED Required

Work Experience:

• 1 year Related experience. Required
• 2 years Revenue Cycle/Healthcare Billing & Insurance Follow up Experience. Preferred

Licenses:

• Certified Revenue Cycle Specialist within 1 year Required

Knowledge, Skills, and Abilities:

• Experience and knowledgeable within the Epic system required.
• Knowledge of billing and healthcare terminology required.
• Excellent communication and interpersonal skills.

Benefits Offered:

• Comprehensive health benefits
• Flexible spending and health savings accounts
• Retirement savings plan
• Paid time off (PTO)
• Short-term disability
• Education assistance
• Financial education and support, including DailyPay
• Wellness and Wellbeing programs
• Caregiver support via Wellthy
• Childcare referral service via Wellthy