Refund and Credit Balance Specialist

University of California - San Francisco; Emeryville (CA); In loco; USD 60.000 - 90.000; Tempo pieno

Descrizione del lavoro

UCSF Health in Emeryville, CA seeks a Senior Government Credit Balance Specialist to resolve credit balances arising from audits, overpayments, or payer adjustments. You will review refunds, coordinate rebilling with primary payors, and ensure compliance with CPT/ICD/DRG coding standards.

You will use EPIC, RevCyclePro and payer portals to analyze data, communicate with care teams and payors, and drive timely resolutions. Strong analytical, organizational and patient-focused skills are essential.

Competenze

• High School diploma or GED with five years of experience, including two years in collections investigation.
• Knowledge of contracts, insurance billing requirements, UB04 claim forms, Medicare, Medi-Cal and compliance program regulations.
• Good analytical and organizational skills, interpersonal, verbal, and written communication skills.
• Must understand CPT, ICD, DRG, and HCPC codes.

Mansioni

• Collections of accounts refunded by the Medical Center and payment retractions generated by the payor.
• Reviewing external auditor refund requests for management approval
• Resolving credits by meeting payor quarterly/annual credit balance report requirements
• Cancelling or adjusting previous claims submissions.

Conoscenze

Credit balance analysis

Collections investigation

Payor coordination

Analytical skills

Interpersonal communication

Formazione

High School Diploma or GED

Strumenti

EPIC

CIRIUS

RevCyclePro

DDE

Descrizione del lavoro

Job Description

The Refund and Credit Balance Specialist also known as our Senior Government Credit Balance Specialist (SGCBS), is responsible for resolving accounts with credit balances. These include credits associated with audit findings and overpayments/overadjustments by payors and patients. Additionally, the SGCBS reviews requests for refunds from payors and coordinates the rebilling process to the primary payor following departmental guidelines. The SGCBS is also responsible for the following but not limited to:

• Collections of accounts refunded by the Medical Center and payment retractions generated by the payor.
• Reviewing external auditor refund requests for management approval
• Resolving credits by meeting payor quarterly/annual credit balance report requirements and;
• Cancelling or adjusting previous claims submissions.

The SGCBS utilizes multiple databases and applications to analyze and take appropriate action on information or documents received. Applications and Databases consist of EPIC, Hospital Rates, CIRIUS, RevCyclePro, Imaging, Refund Database, DDE and various payer websites. Frequent contact with Patient Financial Services staff, departments and management, as well as patients, billing and professional fee and collection services vendors.

Qualifications

Requirements:

• High School diploma or a GED and five years of experience, including two years of experience in collections investigation; or an equivalent combination of education and experience.
• Knowledge of contracts, insurance billing requirements, UB04 claim forms, Medicare, Medi-Cal and compliance program regulations.
• Good analytical and organizational skills, interpersonal, verbal, and written communication skills.
• Knowledge of computer operation, keyboard functions, calculator, copier and fax machine operation.
• Adequate keyboard skills.
• Proactive and assertive account resolution skills.
• Must be a motivated individual with a positive and exceptional work ethics.
• Ability to follow directions and written procedures.
• Ability to balance assertiveness with compassion for the patient and others.
• Must have a thorough understanding of CPT, ICD, DRG, and HCPC codes.
• Must have a thorough understanding of stop losses, per diems, carve outs and other contract terms and conditions.
• Computer software skills (i.e. Microsoft Applications and E-mail, etc.).
• The ability to work in Emeryville when required.
• This requirement is applicable to Internal applicants only: Must demonstrate an in-depth understanding of all aspects of billing greater than an Office Assistant III and Senior Collections Rep I.

Preferences:

• Medical terminology experience.
• Understanding of HIPAA rules and regulations

About UCSF

The University of California, San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It is the only campus in the 10-campus UC system dedicated exclusively to the health sciences. We bring together the world’s leading experts in nearly every area of health. We are home to five Nobel laureates who have advanced the understanding of cancer, neurodegenerative diseases, aging and stem cells.

Pride Values

UCSF is a diverse community made of people with many skills and talents. We seek candidates whose work experience or community service has prepared them to contribute to our commitment to professionalism, respect, integrity, diversity and excellence - also known as https://www.ucsf.edu/about/mission-and-values . In addition to , UCSF is committed to equity - both in how we deliver care as well as our workforce. We are committed to building a broadly diverse community, nurturing a culture that is welcoming and supportive, and engaging diverse ideas for the provision of culturally competent education, discovery, and patient care. Additional information about UCSF is available https://diversity.ucsf.edu/ . Join us to find a rewarding career contributing to improving healthcare worldwide.

EEO Statement

The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected status under state or federal law.