Start the day excited to make a difference…end the day knowing you did.  Come join our team.

Job Summary:

This position is accountable to perform all duties associated with the timely, accurate resolution of credit balance accounts and refund processing to third party payers, patients or guarantors. The incumbent in this position will support the mission, vision, values and strategic initiatives of Mary Washington Healthcare and must demonstrate a commitment to quality service to patients, physicians, the public and co-workers.

Essential Functions & Responsibilities:

• Follow Federal regulations and guidelines to ensure accurate credit balance and refund resolution.
• Research and resolve all refunds/credit balances to maintain compliance with hospital goals.
• Review all credit balance accounts, process refund requests and correcting any billing errors based on established policies and procedures to ensure appropriate account resolution.
• Works credit balance accounts and refunds daily. Adheres to refund/credits metrics.
• Submits or documents refund/credit information in the financial system for all appropriate accounts.
• Prints relevant documentation as needed for refund/credit processing and/or resolution.
• Understands the download and transmission functions of claims.
• Validates appropriateness of all Medicare credit balances and submits the necessary adjustments to Medicare or adjustment forms to appropriate staff for resolution. Also responsible for preparing the detail of the Medicare Quarterly Credit Balance report.
• Compares third party refund requests to contract to determine appropriateness of refund request.
• Documents and communicates all trends to the Supervisor/Manager and makes recommendations of possible resolutions for those trends in an accurate and timely manner.
• Acts as a resource for knowledge of regulations and guidelines.
• Timely and appropriate response to phone calls, internal questions, and correspondence from various departments, outside agencies, and payers regarding information pertaining to, but not limited to, credit balance resolution and refund processing.
• Requests information from other departments to process refunds/credits in a timely manner.
• Timely reporting of Compliance issues to Supervisor/Manager.
• Organizes job functions and work assignments to be able to effectively complete assignments within established time frames.
• Demonstrates knowledge of all equipment and systems/technology necessary to complete duties and responsibilities.
• Prepare the Medicare and Medicaid credit report for Supervisor review and submission.
• Participates in the orientation and training of new staff.  Provides feedback to leadership regarding team performance.
• Acts as a subject matter expert and assists team members with credit and refund questions or issues.
• Works with team members to identify information system issues, submit problem tickets, and ensure issues are resolved.
• Monitors follow-up work queues for productivity and notifies leadership if there is a need for intervention or work reassignments.
• Performs other duties as assigned

Qualifications:

• High school diploma or equivalent required.
• Two years healthcare credit balance, follow-up or billing experience required.
• Three years healthcare related experience required.
• Must be keyboard literate.
• Must demonstrate excellent verbal and written communication skills as well as analytical skills.

As an EOE/AA employer, the organization will not discriminate in its employment practices due to an applicant's race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status.