Credit and Refund Representative I - York - Days

Hospital And Professional Billing Insurance Credits Specialist

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

Work Experience :

Licenses :

Knowledge, Skills, and Abilities :

Benefits Offered :

WellSpan Health's vision is to reimagine healthcare through the delivery of comprehensive, equitable health and wellness solutions throughout our continuum of care. As an integrated delivery system focused on leading in value-based care, we encompass more than 2,300 employed providers, 250 locations, nine award-winning hospitals, home care and a behavioral health organization serving central Pennsylvania and northern Maryland. Our high-performing Medicare Accountable Care Organization (ACO) is the region's largest and one of the best in the nation. With a team 23,000 strong, WellSpan experts provide a range of services, from wellness and employer services solutions to advanced care for complex medical and behavioral conditions. Our clinically integrated network of 3,000 aligned physicians and advanced practice providers is dedicated to providing the highest quality and safety, inspiring our patients and communities to be their healthiest.

Quality of Life : Founded in 1741, the city of York is considered by many as the first capital of the United States. The Articles of Confederation were signed by the Second Continental Congress here in 1777. Its beautifully restored historic district is an architectural treasure. While York retains its farming and manufacturing heritage, at its heart York is a thriving cultural community that has attracted creative talent and innovative entrepreneurial investors from across the nation. Life in York County offers affordable housing, options for higher education, a thriving arts and cultural community, historical attractions, parks and recreational resources, semi-professional baseball team, fine dining and more - within an easy drive of major East Coast cities. York County residents can find local employment in healthcare, manufacturing, technology, agricultural and service sectors. (Patient population : 445,000)

WellSpan Health is an Equal Opportunity Employer. It is the policy and intention of the System to maintain consistent and equal treatment toward applicants and employees of all job classifications without regard to age, sex, race, color, religion, sexual orientation, gender identity, transgender status, national origin, ancestry, veteran status, disability, or any other legally protected characteristic.