Credit Balance Specialist Jobs

Faculty Practice Plan Services (University of Washington Physicians) is the practice group for more than 3,000 physicians and other healthcare professionals associated with UW Medicine. UW Medicine includes Harborview Medical Center, UW Medical Center, UW Neighborhood Clinics, the UW School of Medicine, Valley Medical Center, and Airlift Northwest. FPPS members also practice at the Seattle Cancer Care Alliance, a partnership of UW Medicine, Fred Hutchinson Cancer Research Center, and Seattle Children’s Hospital.

The Credit Balance Specialist is responsible for analyzing credit balances on patient accounts to determine proper steps for resolution, responding to refund request letters from insurance carriers, reviewing manual refund requests generated by outside entities including requests from other UWP departments and hospital clinic staff, and assisting in posting insurance payments and denials to patient accounts as needed.

Essential Duties and Responsibilities:

Analyze EPIC accounts in assigned credit balance (CB) work queues to resolve both distributed and undistributed credit balances.
Determine proper coordination of benefits.
Add missing coverage(s) to EPIC accounts and/or update any outdated coverage information.
Add account comments regarding coverage changes/additions, documenting who was consulted (payer contact name and phone number, reference to website, etc.).
Analyze credit balance inquiries and potential refund requests from other internal UWP departments. These include verbal, phone, and email requests, as well as direct account transfers into specially marked high priority work queues.
Process Compliance Department refund requests as a top priority. Adjust work schedule and priorities as needed to accommodate for any special compliance refund projects.
Identify payer-specific trends such as: o New ANSI codes that appear to be mis-mapped (on either the payer side or the UWP side).
Sudden spikes in denials linked to a specific proprietary EOB code.
Write-offs not being taken when certain EOB codes are entered o Balances NRPing when they should not, or vice versa.
Maintain various MS Excel spreadsheets and MS Access databases to track credit balance refunds produced and collection agency referrals paid directly to UWP.
Maintain daily time-tracking statistics in MS Excel
Perform other duties, as assigned.

MINIMUM QUALIFICATIONS

High School graduation or equivalent AND two years of experience in patient accounting, customer service, or a related office environment

OR

Equivalent education/experience.