PFS Credit Balance Representative - 40 hrs / wk, 1st shift

PURPOSE OF THIS POSITION

The Credit Balance Representative analyzes posted transactions to determine why there is a credit balance. This position requires detailed analysis and critical thinking to determine what is necessary to correct the account. After review, if a refund is appropriate to either the patient or insurance company, a payment transfer is necessary, or a reversal or correction of contractual allowance or an administrative adjustment is warranted, the representative is responsible to correct the postings and / or refund the overpayment to the correct payer(s).

JOB DUTIES / RESPONSIBILITIES

• Duty 1. Researches and resolves credit balances on both self-pay and insurance lines. Having a clear understanding of payment posting processes to resolve these issues. Documents all patient accounts activities concisely, including future steps needed for resolution.
• Duty 2. Responsible for refunding overpayments on accounts or transferring payments to the appropriate account / accounts.
• Duty 3. Returns phone calls, referrals, or emails promptly and in a courteous manner.
• Duty 4. Understands different payer regulations and can communicate effectively with patients regarding their Explanation of Benefits (EOB)
• Duty 5. Performs filing, data entry, and other duties as assigned.
• Duty 6. Identifies barriers to efficient departmental operations and takes an active role in developing appropriate and effective solutions.
• Duty 7. Handles telephone questions and concerns from patients, payers, internal / external staff. ensures complaints and inquiries are recorded and reported to Leadership.
• Duty 8. Monitors, completes, and maintains appropriate productivity levels of assigned tasks in accordance with team standards.
• Duty 9. The above duties reflect the general duties considered necessary to describe the principal functions of the job as identified and should not be considered a detailed description of all the work requirements that may be inherent to the position.
• Duty 10. Maintains a thorough understanding and education of federal and state regulations and payer specific policies and requirements to promote compliant credit and collection practices. Adheres to HIPAA related privacy, security and transaction & code set regulations in compliance with the federal guidelines. Accurately documents all account activity. Regularly attends and actively participates in staff meetings, in-service, and continuing education programs as offered. This provides needed educational updates for compliancy and organizational changes in the healthcare industry.
• Duty 11. Regularly attends and actively participates in staff meetings, training and continuing education that aligns with recognized improvement opportunities, payer policies and procedures and ensures to maintain up to date certifications. This could be remote and / or onsite as necessary, per the BVHS remote policy. Assists in other duties and projects as needed assigned by the supervisor and / or manager.

REQUIRED QUALIFICATIONS

PREFERRED QUALIFICATIONS

PHYSICAL DEMANDS

This position requires a full range of body motion with intermittent bending, squatting, kneeling, and twisting. The associate must be able to sit for three hours, walk for one hour and stand for two hours per day. The associate must be able to lift 20 pounds. The individual must have excellent eye / hand coordination to operate the machines. This position requires corrected vision and hearing in the normal range.