Credit Balance Specialist - Patient Accounting

Location: 9521 San Mateo NE, Albuquerque, NM 87113-2237

About the Role

Presbyterian is hiring a skilled Credit Balance Specialist to join our team at the Reverend Hugh Cooper Administrative Center. This is a full-time, non-exempt position working day shifts.

Responsibilities

• Analyzes and validates accuracy of all accounts with credit balances to determine whether payments and allowances posted are accurate according to contractual agreements and determines if a refund or adjustment is required to resolve/close the account.
• Performs accounts receivable credit balance reimbursement analysis to determine if reimbursement, allowances, and patient payments received are correct. Makes appropriate adjustments and refers any refunds to the Cash Processing team.
• Documents accounts in accordance with established PHS policies and procedures.
• Manages the credit balance report and external correspondence relating to overpayments made by insurance payors or patients within established timeframes.
• Identifies and documents any insurance payer or internal issues as they arise. Communicates all issues to teammates, Supervisor, or Manager. Maintains a file containing all pertinent information for each issue, including correspondence, EOBs, and claims.
• Contacts insurance companies, patients, employers, etc., to resolve any overpayment issues that require their assistance.
• Develops positive working relationships and works closely with all outside agencies contracted with Presbyterian, as well as all third-party payers, to effectively communicate and resolve overpayment issues.
• Works closely with all PHS departments and teams regarding discrepancies in charges, payments, allowances, etc., posted to accounts.
• Acts as an effective team member with good communication and organizational skills. Participates in team meetings, communicates work-related ideas and concerns proactively, and assists in finding appropriate resolutions.
• Adheres to all PHS and Patient Accounting Policies and Procedures to promote a smooth working environment and upholds PHS Vision by practicing the CARES behavior at all times.
• Cross-trains in various patient accounting areas to become familiar with all aspects of Patient Accounting functions as they relate to account reconciliation and refunds.
• Performs other duties assigned by the Credit Balance/Refund Supervisor and/or Cash Application Manager.

Requirements

• High school degree or GED is required.
• Minimum two years of experience in insurance follow-up, billing, and collections.
• One year of experience in a similar medical facility, physician’s office, or with a major carrier in claims processing preferred.
• Demonstrated ability to communicate effectively via telephone and in writing.
• Computer literate.
• Ability to work closely with co-workers.

Pay

Pay Range: $16.66 – $26.70 per hour.

Benefits

• Comprehensive benefits package including medical, dental, vision, short-term and long-term disability, and group term life insurance.
• Optional voluntary benefits.
• Wellness rewards program offering gift cards and incentives for participation in wellness activities, challenges, webinars, and preventive screenings.

About Presbyterian Healthcare Services

Presbyterian exists to improve the health of patients, members, and the communities we serve. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan, and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees—including more than 1,600 providers and nearly 4,700 nurses. Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care), and Commercial health plans.

As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.