AR Medical Claims Credit Analyst - Sevita
Sarasota, FL
About the Job
At Sevita we believe that everyone deserves to live well. For more than 50 years, our team members have provided home and community-based health care for adults, children and their families across the United States. As a member of our corporate team, you’ll help shape the work that supports how our business runs, the services we provide, and the relationships we build with those we serve and each other. Join us, and experience a career well lived.
The AR Credit Balance Analyst is responsible for the review, analysis and resolution of credit balances within the Revenue Cycle. Analyst responsibilities include oversight of credit balances on the AR aging as well as associated AR adjustments and refunds, with a focus on quality and accuracy. This position requires the analyst to work independently and collaborate with others to solve complex issues, while demonstrating timely and accurate adjudication of credit balances. They will perform these duties while meeting the mission and goals of Sevita.
This role is an in person role, reporting to the Sarasota, FL office.
_Responsibilities:_
• Collaborate with Director, Supervisors and Managers to define opportunities and priorities
• Utilize AR software applications to run various system reports to identify credit balances.
• Identify root causes, trends and process deficiencies that lead to credit balances and assist with development of action plan and implementation.
• Collaborate with other teams and departments to optimize controls over account set-ups and processes to stop data issues resulting in credit balances.
• Work credit balances on the AR aging following standard procedure for resolution.
• Comprehension of payor, government, and state refund processes to ensure the company is adhering to payor policies by reviewing payor websites and bulletins.
• Research complex accounts to determine most appropriate method of credit resolution; payment refund, correction to cash application, correction to liability distribution or adjustments to AR.
• Review third party supporting documentation such as rate agreements or contracts to determine the correct reimbursement amount.
• Navigate payor websites and portals to locate pertinent information necessary to research and resolve credit balances.
• Analyze and utilize data from Explanation of Benefits, Remittance Advice, and COB rules to resolve credit balances.
• Handle correspondence sent by payors relating to refund requests and overpayments.
• Reconciliation of approved refunds and applicable systems, Avatar subledger & GL overpayment account.
• Ensure internal control compliance with all assigned areas and other audit requirements.
• Embrace concept mentoring by actively participating in team meetings and fostering an environment in which team members proactively collaborate with one another
• Proactively support management as well as the objectives and goals of the department.
• Supports special projects, mission critical initiatives and performs other duties as assigned by the Supervisor or Director.
• Responsible for the maintenance of an effective control environment under SOX 404 for the accounting operations he or she oversees. This includes both key and non-key controls and extends to the timely updating and modification of control design where necessary and the oversight of control remediation activities should exceptions be encountered in testing
_Qualifications:_
• Bachelor's degree in a Finance related field required or equivalent experience
• Three years of experience with Medical Collections in a high volume environment preferred
• In-depth knowledge of AR aging, credits balances, billing, collections and cash applications
• Strong understanding of Medicaid, Medicaid managed care, Commercial, Workers Comp and Auto-no-fault payer types
• Must be self-motivated and detail oriented
• Must have excellent communication skills (oral and written)
• Must be highly organized with ability to multi-task
• Excellent analytical, problem solving skills with a high attention to detail
• Must be able to collect and analyze information from different sources
• Intermediate use of Microsoft Office (Word, Excel, PowerPoint, Outlook, etc.)
• Must be able to work effectively independently and in a team environment
_Why Join Us?_
+ Full compensation/benefits package for employees working over 30 hours/week
+ 401(k) with company match
+ Paid time off and holiday pay
+ Enjoy complex work that makes a difference in the lives of those we serve
+ Career development and advancement opportunities across a nationwide network
Sevita is a leading provider of home and community-based specialized health care. We believe that everyone deserves to live a full, more independent life. We provide people with quality services and individualized supports that lead to growth and independence, regardless of the physical, intellectual, or behavioral challenges they face. We’ve made this our mission for more than 50 years. With Corporate operations located in the Boston Seaport, Lawrence, Massachusetts and Edina, Minnesota, today, our 40,000 team members continue to innovate and enhance care for the 50,000 individuals we serve.
Equal Opportunity Employer, including disability/vets.
The AR Credit Balance Analyst is responsible for the review, analysis and resolution of credit balances within the Revenue Cycle. Analyst responsibilities include oversight of credit balances on the AR aging as well as associated AR adjustments and refunds, with a focus on quality and accuracy. This position requires the analyst to work independently and collaborate with others to solve complex issues, while demonstrating timely and accurate adjudication of credit balances. They will perform these duties while meeting the mission and goals of Sevita.
This role is an in person role, reporting to the Sarasota, FL office.
_Responsibilities:_
• Collaborate with Director, Supervisors and Managers to define opportunities and priorities
• Utilize AR software applications to run various system reports to identify credit balances.
• Identify root causes, trends and process deficiencies that lead to credit balances and assist with development of action plan and implementation.
• Collaborate with other teams and departments to optimize controls over account set-ups and processes to stop data issues resulting in credit balances.
• Work credit balances on the AR aging following standard procedure for resolution.
• Comprehension of payor, government, and state refund processes to ensure the company is adhering to payor policies by reviewing payor websites and bulletins.
• Research complex accounts to determine most appropriate method of credit resolution; payment refund, correction to cash application, correction to liability distribution or adjustments to AR.
• Review third party supporting documentation such as rate agreements or contracts to determine the correct reimbursement amount.
• Navigate payor websites and portals to locate pertinent information necessary to research and resolve credit balances.
• Analyze and utilize data from Explanation of Benefits, Remittance Advice, and COB rules to resolve credit balances.
• Handle correspondence sent by payors relating to refund requests and overpayments.
• Reconciliation of approved refunds and applicable systems, Avatar subledger & GL overpayment account.
• Ensure internal control compliance with all assigned areas and other audit requirements.
• Embrace concept mentoring by actively participating in team meetings and fostering an environment in which team members proactively collaborate with one another
• Proactively support management as well as the objectives and goals of the department.
• Supports special projects, mission critical initiatives and performs other duties as assigned by the Supervisor or Director.
• Responsible for the maintenance of an effective control environment under SOX 404 for the accounting operations he or she oversees. This includes both key and non-key controls and extends to the timely updating and modification of control design where necessary and the oversight of control remediation activities should exceptions be encountered in testing
_Qualifications:_
• Bachelor's degree in a Finance related field required or equivalent experience
• Three years of experience with Medical Collections in a high volume environment preferred
• In-depth knowledge of AR aging, credits balances, billing, collections and cash applications
• Strong understanding of Medicaid, Medicaid managed care, Commercial, Workers Comp and Auto-no-fault payer types
• Must be self-motivated and detail oriented
• Must have excellent communication skills (oral and written)
• Must be highly organized with ability to multi-task
• Excellent analytical, problem solving skills with a high attention to detail
• Must be able to collect and analyze information from different sources
• Intermediate use of Microsoft Office (Word, Excel, PowerPoint, Outlook, etc.)
• Must be able to work effectively independently and in a team environment
_Why Join Us?_
+ Full compensation/benefits package for employees working over 30 hours/week
+ 401(k) with company match
+ Paid time off and holiday pay
+ Enjoy complex work that makes a difference in the lives of those we serve
+ Career development and advancement opportunities across a nationwide network
Sevita is a leading provider of home and community-based specialized health care. We believe that everyone deserves to live a full, more independent life. We provide people with quality services and individualized supports that lead to growth and independence, regardless of the physical, intellectual, or behavioral challenges they face. We’ve made this our mission for more than 50 years. With Corporate operations located in the Boston Seaport, Lawrence, Massachusetts and Edina, Minnesota, today, our 40,000 team members continue to innovate and enhance care for the 50,000 individuals we serve.
Equal Opportunity Employer, including disability/vets.
Source : Sevita
