Credit Balance Analyst

Responsible for timely research and resolution of insurance credit balances on highly complex cases. Performs necessary functions to refund overpayments from insurance carriers within 30 days of receipt. Manage work queues related to insurance overpayments and insurance credit balances. Identify trends, potential resolutions and escalate to manager. Evaluate accuracy of contract modeling, communicate findings, and escalate as appropriate. Responsible for reporting state Medicaid's credit balances on a quarterly basis. Participate in payer meetings to resolve issues. Responsible for ensuring solutions implemented and goals achieved. Identify and monitor CMS & payor rule changes and work to ensure compliance. Minimum Education

Bachelor's Degree (Preferred)

Minimum Work Experience

3 years Related patient accounting experience required, especially related to insurance overpayments trending and root cause analysis (Required)

Required Skills/Knowledge

Excellent working knowledge of complex contract reimbursement methodologies including transplant, global, APR DRGs among others.

Proven analytical skills including ability to make recommendations based on financial analysis.

Excellent PC skills including advanced skill proficiency in Access and Excel spreadsheet analysis.

Ability to work in a team environment with other analysts, managers, and department leaders.

Proficiency in presentation of analytical results.

Excellent working knowledge of coding & NCCI edits.

Demonstrated knowledge of managed care payer requirements in an acute hospital setting.

Demonstrated ability to facilitate team or group activities.

Excellent verbal and written communication skills.

Demonstrated ability to be flexible and to prioritize workload & decision-making skills.

Ability to analyze workflow for process improvement.

Strong organizational and coordination skills required.

Functional Accountabilities

Account Follow-up

Ensure all assigned claims and encounters are reviewed in a timely manner as per standard operating procedure (SOP)

Evaluate contract management expected reimbursement and follow appropriate guidelines to report and escalate discrepancies

Assess overpayments and process timely as per procedures

Rebill claim or issue refund as appropriate to facilitate payment retraction or refund

Establish a system to ensure refund requests from insurance carriers are processed within 30 days of receipt

Read and interpret payer contracts for accuracy when submitting refund request for approval

Ensure appropriate supporting documentation is included with refunds

Report state Medicaid’s credit balances on a quarterly basis Data Analysis and Issue Resolution

Manage matrix of issues & resolutions including accountable stakeholders; ensure results and escalate issues as appropriate; regularly report updates and challenges to manager

Conduct root cause analysis of issues affecting overpayments. Identify key issues and assist in tracking, trending and reporting

Present data and analysis clearly to all levels of staff and management

Meet with manager and outside departments to review issues and develop action plans

Assist in development of solutions, training & education guidelines to resolve issues and share data with staff and management

Appropriately engage and involve key accountable stakeholders in a collaborative manner

Research payer & CMS policies related to revenue cycle; identify & alert stakeholders of required changes; track and ensure completions

Organizational Accountabilities

Track Refunds

Maintain a refund request log to monitor the request, issuance, mailing and posting of refunds.

Provide supporting documentation to Accounts Payable with completed signatures and back up.Organizational Commitment/Identification

Partner in the mission and upholds the core principles of the organization

Committed to diversity and recognizes value of cultural ethnic differences

Demonstrate personal and professional integrity

Maintain confidentiality at all timesCustomer Service

Anticipate and responds to customer needs; follows up until needs are metTeamwork/Communication

Demonstrate collaborative and respectful behavior

Partner with all team members to achieve goals

Receptive to others’ ideas and opinionsPerformance Improvement/Problem-solving

Contribute to a positive work environment

Demonstrate flexibility and willingness to change

Identify opportunities to improve clinical and administrative processes

Make appropriate decisions, using sound judgmentCost Management/Financial Responsibility

Use resources efficiently

Search for less costly ways of doing thingsOrganizational Accountabilities (Staff)

Organizational Commitment/Identification

Anticipate and responds to customer needs; follows up until needs are met

Teamwork/Communication

Demonstrate collaborative and respectful behavior

Partner with all team members to achieve goals

Receptive to others’ ideas and opinions

Performance Improvement/Problem-solving

Contribute to a positive work environment

Demonstrate flexibility and willingness to change

Identify opportunities to improve clinical and administrative processes

Make appropriate decisions, using sound judgment

Cost Management/Financial Responsibility

Use resources efficiently

Search for less costly ways of doing things

Safety

Speak up when team members appear to exhibit unsafe behavior or performance

Continuously validate and verify information needed for decision making or documentation

Stop in the face of uncertainty and takes time to resolve the situation

Demonstrate accurate, clear and timely verbal and written communication

Actively promote safety for patients, families, visitors and co-workers

Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance