This position identifies accounts with credit balances, determines the nature of the credit balance and processes the refund or contractual adjustment while also maintaining the integrity of cash and accounts receivable transactions to ensure maximum efficiency and accuracy of accounts receivable balances. This position also inputs adjustment data into patient accounts and ensures that work complies with all cash related procedures and financial control policies set by the finance department.
- Family-Centered care that focuses on the need of the child first and values the family as an important member of the care team
- Excellence in clinical care, service and communication
- Collaborative within our institution and with others who share our mission and goals
- Leadership that set the standard for pediatric health care today and innovations of the future
- Accountability to our patients, community and each other for providing the best in the most cost-effective way.
Reviews patient accounts with credit balances to determine the nature of the credit balance.
- Evaluates credit balances reported on the Credit Balance Report daily and posts adjustments or processes refunds as needed. Communicates to supervisor any trends or patterns identifying inaccurate activity transpiring on patient accounts causing unnecessary credit balances.
Analyzes accounts for patient refunds, insurance refunds, contractual adjustments or transfers using the tools provided.
- Uses payer contracts to identify over-allowed claims and determine appropriate insurance reimbursement. Verifies applicable contract rates by reviewing EOB messages, denials, and member insurance information. Uses knowledge of managed care contracts and government legislation to ensure refund request are within refund processing guidelines. Issue refund request denial letters based on contract and timely guidelines.
Reviews correspondence from insurance companies to determine if request is for approved or denied refunds.
- Establishes communications with other departments, vendors, and guarantors for reconciliation of credit balance accounts. Collaborates with PCMG to resolve open credit balances before initiating refunds. Submits requests for corrected or void claims to prompt insurance recoups. Sends overpayment letters to AHCCCS plans to prompt recoups.
Reviews and verifies accuracy of approved refunds.
- Prepares refunds for mailing and documents activity in an accurate and timely manner on the patients account. Scans supporting documentation to patients account in ChartMaxx. Mails check to individual that is due a refund.
- Performs miscellaneous job related duties as requested.