Credit Balance Specialist

Clerical/Admin Escondido, California

Requisition ID
Patient Financial Services
Escondido, California
Not Applicable
Job Type
Hours Per Shift
Hours Per Pay Period

Responsible for the appropriate adjudication and processing of all credit balances. Responsible for identifying all credit balances and working them based on priorities assigned by the Supervisor or Manager. Responsible for analysis of the reason for credit balance and determining the appropriate adjudication of the account whether applying a contractual allowance or issuing a refund. Responsible for providing information and documentation to insure timely and accurate refund processing. Manages and assembles all data and documentation required for accurate follow-up of credit balances for Medicare and the timely submission of the quarterly Medicare Audit report. Credit Balance analysis is performed on all inpatient and outpatient encounters. Ability to perform complex mathematical calculations to adjudicate accounts appropriately. Ability to analyze and adjudicate complicated contractual arrangements as determined by contractual agreements entered into by Palomar Health. Reviews remittance codes from EOB�s and R/A�s to identify credit balances if appropriate. Works the daily hospital information systems queues set up for their credit balance assignments/payers as directed by Leadership. Refers all payer issues/problems to Leadership in a timely manner with specific examples. Responsible for complete, accurate, and timely documentation of all follow up pertaining to the resolution of the account within the hospital information systems patient financial record. Duties include researching, reviewing, and adhering to all federal, state, and local regulatory billing, collection, and refund guidelines as well as payer specific billing/collection guidelines. Responsible to direct credit balances/refunds to appropriate person for resolution based on dollar and age parameters. Sets goals and objectives to maintain and exceed the key performance indicator for credit balances at 1 day of gross AR. Implements strategies to optimize the total collected value of each patient account that is assigned. Maintains high productivity and quality with minimal supervision and represents team at standing information meetings. Takes department issues to the meetings, presents issues and reports back to the team. Maintains and updates training manual for specific portion of the A/R (Accounts Receivable) and works in collaboration with internal (PFS) and external customers. Customer service and satisfaction are key standards for all communications. Work will be subject to compliance reviews and productivity standards. Yearly continuing education is required. Participates in the training of new and temporary staff members as directed by Leadership. Speak and read English at a level that is sufficient to satisfactorily perform the essential functions of the position. Knowledge of standard office equipment (i.e., calculator, fax, photocopier) and personal computer and computer software skills (i.e., MS Windows, Excel, Access, Word, Powerpoint, internet, e-mail). Windows computer skills including proficient use of keyboarding, use of mouse or keys for functions such as selecting items, use of drop down menus, scroll bars, opening folders, copying and similar operations required upon employment or within the 1st two weeks of employment to perform the essential functions of the job. Performs other duties as assigned. Follows Palomar Health rules, policies, procedures, applicable laws and standards. Carries out the mission, vision, and quality commitment of Palomar Health.

Job Requirements

Minimum Education: High School Diploma or combination of education and experience
Preferred Education: Not Applicable
Minimum Experience: 1 year hospital patient accounting experience
Preferred Experience: Not Applicable
Required Certification: Not Applicable
Preferred Certification: Not Applicable
Required License: Not Applicable
Preferred License: Not Applicable

We are an equal opportunity employer and do not discriminate against applicants or employees based on race, color, gender, religion, creed, national origin, ancestry, age, disability, sexual orientation, marital status or any other characteristic protected by law.