Hospital Credit Balance Specialist

United Surgical Partners International Inc (USPI); Dallas (TX); On-site; USD 40,000 - 70,000; Full time

Job summary

Join a forward-thinking company as a Hospital Refund Specialist, where you will play a vital role in ensuring timely refunds for patient accounts. This position requires a keen eye for detail and strong problem-solving skills as you navigate through various payer systems and manage credit balances. You'll collaborate closely with peers and stakeholders, ensuring compliance and delivering exceptional customer service. If you have a passion for healthcare finance and a knack for organization, this role offers a fulfilling opportunity to make a difference in patient care and financial accuracy.

Qualifications

• High school graduate with proficiency in office software and credit balance resolution.
• 2 years of experience in CBO related to Billing, Cash Collections, and Disputes.

Responsibilities

• Identify and resolve credit balances on patient accounts for timely refunds.
• Collaborate with clients and internal stakeholders to ensure compliance.

Skills

Problem-solving

Organizational skills

Communication skills

Analytical skills

Education

High school diploma or equivalent

Tools

Excel

Word

Outlook

nThrive

Availity

Job description

Role and Responsibilities:

The Hospital Refund Specialist has the responsibility of identifying and resolving credit balances on patient accounts to ensure refunds are issued in a timely manner. This position ensures the highest quality and safe delivery of customer service, maintaining compliance with professionalism and regulatory processes. Interface with facility clients and internal corporate stakeholders.

• Manage daily work queues of credit balances for both onshore & offshore teams.
• Research, initiate follow-up and resolve all health care insurance claim accounts with existing credit balances.
• Complete thorough review of patients’ accounts with credit balances to validate the patient overpayment is accurate.
• Recommend an adjustment when applicable or recommend a refund of the overpayments to the insurance carrier or patient, providing the appropriate documentation.
• Apply knowledge related to insurance contracts, interpret explanation of benefits, understand regulations concerning coordination of benefits and other applicable guidelines.
• Process refunds accurately and in a timely manner adhering to contract language where appropriate.
• Navigate through various payer systems and multiple internal systems to ensure timely and accurate resolution of claims.
• Use critical and analytical problem-solving skills to resolve issues.
• Utilize strong organizational skills to effectively manage large amounts of detailed information.
• Utilize excellent written and oral communication skills to collaborate and maintain positive working relationships with peers, leaders, surgery centers, and payer representatives to resolve credit balances.
• Consistent, regular, punctual attendance as scheduled is an essential responsibility of this position.
• Other duties as assigned.

Qualifications and Education Requirements:

• High school graduate or equivalent.
• Must have the skills necessary to operate the office equipment required to fulfill job duties.
• Proficient in Excel, Word, and Outlook.
• Able to navigate through nThrive and Availity (preferred).
• Previous credit balance resolution experience in a facility or CBO environment.
• 2 years combined experience in CBO related to Billing, Cash Collections, Denials, Disputes, Follow-up, and/or Appeals.
• Understanding of medical terminology.
• Basic understanding of credit and refund guidelines.

This is not an all-inclusive list. Additional tasks and responsibilities may be added by management based on business need.