Team Lead Credit Balance Resolution - ECU Health

ECU Health

About ECU Health Medical Center

ECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet® designation twice and provides acute and intermediate care, rehabilitation and outpatient health services to a 29-county region that is home to more than 1.4 million people.

Position Summary

The position serves as a technical expert lead for other Credit Balance Resolution staff and is responsible for training new staff, providing ongoing training to existing staff, as well as performing all of the duties of the Credit Balance Resolution Specialist. A significant degree of independent judgment and decision making is required.
Responsible for ensuring the Medicare quarterly credit balance report is completed in a timely manner along with all other governmental credit balance audits requests and unclaimed property. It provides some leadership and direction of the credit balance staff in daily credit balance workflow functions. Assist in creating, implementing and updating the policies and procedures for Credit Balance Resolution as well as following the departmental policies and procedures.

Responsible for resolving credit balances, undistributed payments, and requests for refunds due to insurance companies, patients, or other payers through extensive phone, fax, and written correspondence. This position is responsible for working with internal and external customers (e.g., third party payers, patients/guarantors, estate representatives, attorneys, employers, and ECU Health employees) to facilitate the prompt resolution of credit balances or requests for refunds.

This involves researching insurance benefits, understanding coordination of benefits between payers, distributing/reapplying or transferring payments to the appropriate date of service/provider or account, and then updating account adjustments, generating refund requests, overpayment notifications or denying refund request according to guidelines. Accurate and timely resolution of overpays, undistributed payments and requests for refunds is based on a knowledge and understanding of contractual obligations as well as regulatory requirements.

Responsibilities

1. Provide general assistance to the Credit Balance team.

2. Train new staff and provide ongoing training for existing staff.

3. Monitor activities performed by Credit Balance staff to make sure that accounts (credit balance, undistributed payments, and requests for refunds) are reconciled appropriately and timely.

4. Complete quality improvement and productivity activities

5. Answer questions regarding team functions and assist with team direction.

6. Reviews credit balances, undistributed payments and requests for refunds to determine the appropriate course of action needed.

7. Conducts timely and accurate review of credit balances, undistributed payments and requests for refunds to determine the appropriate course of action needed.

8. Initiate refunds to patients/guarantors, insurance companies, and other third parties by following established refund.
procedures, contractual obligations, payer and regulatory requirements.

9. Conduct timely and accurate review of refund requests from payers with contracted recoupment language to reduce.
future recoupment reconciliations.

10. Responsible for reviewing, validating and correcting adjustments on accounts based on insurance reimbursement, benefit coverage guidelines, contracted payers, and services provided.

11. Redistribute and/or transfer payments between PB/HB accounts.

12. Validate and update patient demographic and insurance information to ensure accuracy of future claims.

13. Reconcile misdirected and clearing accounts by researching and posting payments to the correct accounts.

14. Ensures correct reimbursement rates are reflected in refund requests.

15. Maintains appropriate and accurate system documentation with notes and standard note codes.

16. Adhere to Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies.

17. Review and resolve accounts assigned via work lists daily as directed by management.

18. Supporting the Manager as needed

Minimum Requirements

Skill Set Requirement:

Strong problem-solving skills

Strong quantitative, analytical and organizational skills.

Advanced understanding of an Explanation of Benefits (EOB)

Knowledge of CPT, ICD-10, and HCPCS coding standards

Understand CMS Memos and Transmittals.

Utilize and understand computer technology.

Communicate orally and in written form.

Ability to manage multiple tasks with ease and efficiency.

Self-starter with a willingness to try new ideas.

Ability to work independently and be result oriented.

Understand insurance terms and payment methodologies.


Required Education/Course(s)/Training:

High school diploma or equivalent

Associate Degree in Business, Finance, Health Information Management and/or three years of experience in a healthcare revenue cycle or clinic operations leadership role with progressive responsibilities

Minimum of five years of experience in insurance, finance, medical office, or customer service-related field.

Knowledge of managed care contract billing guidelines is required.

Revenue Cycle (healthcare business, financial, or insurance) experience
Epic experience

Knowledge of medical and insurance terminology, CPT, ICD & HCPCS coding structures, and billing forms (UB, 1500)

Required Certification/Registration: None

Performance Expectations:

Required Skills, Knowledge, and Abilities:

Effective interpersonal skills, including the ability to promote teamwork. Must have excellent time management skills and be able to handle multiple, simultaneous tasks effectively and efficiently while maintaining a professional, courteous manner.

Basic math skills and knowledge of general accounting principles

Ability to ensure a high level of customer satisfaction.

Must be able to work well with others.

Strong verbal and written communication skills required.

Must be detail oriented and organized.

High integrity, including maintenance of confidential information.

Must be able to exercise good judgment and positively influence and lead others, including handling confrontations with poise and efficiency.

Illustrates autonomous, best revenue cycle practices.

Illustrates proficiency in the use of all internal automation and software applications.

General Statement

It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant’s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.