Credit Balance Analyst

Location
Silver Spring, Maryland-Silver Spring
Posted
Oct 13, 2021
Closes
Nov 17, 2021
Ref
2100033B
Function
Nurse
Industry
Healthcare
Hours
Full Time
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.

Qualifications

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)

3 years Experience with reviewing and interpreting complex contract reimbursement methodologies and application to refunds. (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 times

Customer Service

  • 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

Organizational 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


Childrens National Hospital is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender, identity, or other characteristics protected by law.

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