Insurance Credits and Refunds Specialist

Bayhealth; Dover (DE); On-site; USD 26,174 - 38,572; Full time

Benefits offered by this job

PTO & Holidays

401(k) Matching

Health, Dental & Vision

Disability & Life Insurance

On-site Child Care

Educational Reimbursement

FSAs

Job summary

Bayhealth Medical Center is seeking a Credit Balance Specialist to reconcile accounts that remain in credit balance due to overpayments and contract adjustments. You will investigate refunds, interpret Medicare/Medicaid terms, and post accurate adjustments with minimal supervision.

Requires three years in hospital billing/collections and knowledge of payer contracts. On-site position with full-time hours, offering comprehensive benefits and educational reimbursement.

Qualifications

• Three (3) years’ experience in hospital billing/collections and/or Banking related collections experience.
• Knowledge of Federal and State regulations for Medicare and Medicaid.
• Ability to interpret contracts for adjustment or refund determinations with little to no assistance.

Responsibilities

• Research accounts in credit balance status and resolve balances.
• Review remittance advice to correct balances or identify refunds due; call payers for more insight.
• Interpret insurance contracts to ensure income is recorded and refunds/adjustments are processed correctly.
• Identify trends with SBO Cash Application to reduce future credit balances.
• Maintain productivity and meet department goals.

Skills

Hospital billing

Collections

Customer service

Education

High School Diploma or GED

Associate Degree

Tools

None

Job description

If you care about the opportunity to grow, to make a difference, to build a future and a life, then we just might have the career for you. Care to talk?

Bayhealth Medical Center is Central and Southern Delaware’s healthcare leader with hospitals in Dover and Milford, as well as stand‑alone Emergency Department in Smyrna and a hybrid Emergency Department and Urgent Care in Milton. We offer various practice settings throughout Kent and Sussex Counties. Bayhealth Medical Center Kent Campus is 90 minutes from Philadelphia, Washington, DC and Baltimore. Our Sussex Campus is 30 minutes to the Delaware beaches and relaxation in the sand!

Bayhealth Medical Center offers a competitive salary and comprehensive benefits package (for eligible positions) including:

• Generous Paid Time Off and Paid Holidays
• Matching 401(k)/403(b) Plans
• Excellent Health, Dental, and Vision
• Disability and Life Insurance options
• On Site Child Care
• Educational Reimbursement
• Health Care and Dependent Care Flex Spending Accounts
• Plus, an array of Voluntary Benefits to include Critical Care Coverage and more!

Location: 30 Old Rudnick Ln

Status: Full Time 80 Hours

Shift: Days

SALARY RANGE: 18.73 - 28.09 HOURLY

General Summary

Responsible for reconciling patient accounts that remain in credit balance status due to overpayment, contract adjustment posting errors, and other issues. Follows proper control procedures for issuing refunds. Investigates and reports trends of issues which result in credit balances. Must be able to correctly interpret insurance contracts making adjustment or refund determinations with little to no assistance.

Responsibilities

• Responsible for researching accounts in a credit balance status and taking the necessary steps to resolve the credit balance. Review remittance advice and other correspondence to correct account balance and/or identify refunds due. Calls payers as appropriate to obtain additional insight into claim processing and payment amount(s). Document outcome of research and actions taken to resolve the credit balance.
• Correctly interprets Federal and State regulations for Medicare and Medicaid and contract terms for Managed Care, Commercial, and Workers Compensation as applicable to ensure all income is appropriately recorded.
• Follows proper control procedures and departmental policy for posting necessary contractual, small balance and/or refund adjustments. Timely and accurate submission of adjustments and refund requests for approval based on departmental approval guidelines.
• Identifies trends and coordinates with SBO Cash Application staff to reduce the volume of credit balance accounts generated from posting activities in the future.
• Prioritizes work to ensure department and corporate goals are met.
• Maintains productivity standards and credit balances less than the value of 1 day of average daily revenue.
• All other duties as assigned within the scope and range of job responsibilities

Required Education, Credential(s) and Experience

• Education: High School Diploma or GED ;
• Credential(s): None Required
• Experience: Required: Three (3) years’ experience in hospital billing/collections and/or Banking related collections experience.

Preferred: Four (4) years’ experience in hospital billing/collections and/or Banking related collections experience.

Preferred Education, Credential(s) and Experience

• Education: Associate Degree
• Credential(s): Certified Revenue Cycle Specialist
• Experience:

To view a full list of all open position at Bayhealth, please visit: https://apply.bayhealth.org/join/