Credits & Refunds Specialist

Job Summary

A credits and refunds specialist at Wellstar reports to the Credits and Refunds Supervisor. The role involves resolving credit balance accounts and processing refunds on hospital and guarantor accounts. Responsibilities include recommending accounts for write-off, meeting productivity standards, providing individual contributions to the team, identifying process improvements, and ensuring compliance with HIPAA privacy standards.

Core Responsibilities And Essential Functions

• Recommend accounts for contractual or administrative write-off, along with appropriate justification and documentation
• Meet productivity standards, targets, error ratios, and reporting requirements as assigned by the department manager or supervisor
• Provide individual contribution to the overall team effort to achieve the department AR goal
• Identify opportunities for system and process improvement and submit to leadership
• Demonstrate knowledge of HIPAA privacy standards and ensure compliance with system PHI privacy practices
• Demonstrate proficient use of systems and execution of processes in all areas of responsibilities
• Follow WellStar general Policies and Procedures, the Departments Policies and Procedures, and the Emergency Preparedness Procedures
• Follow JACHO and outside regulatory agencies mandated rules and procedures
• Utilize assigned menus and pathways in the hospital mainframe system and report software application problems to the appropriate supervisor
• Utilize assigned menus and pathways in foreign software applications and report software application problems to the appropriate supervisor
• Utilize assigned computer hardware and report hardware problems to the appropriate supervisor
• Participate in the testing for assigned software applications, including verification of field integrity
• Accurately complete special projects as assigned by leadership
• Knowledge and understanding of all needed system functions
• Knowledge of imaging system utilized
• Knowledge of Excel and Word as required for job functions
• Cross training of departmental job functions
• Positive team member and communication
• Perform other duties and responsibilities as assigned

Credit Resolution Responsibilities

• Responsible for reviewing and resolving credit balances on designated accounts
• Reading and understanding all Managed Care contracts and payer requirements
• Administering appeals for refunds requested in error
• Accurately compose account information for review and approval by supervisor
• Maintain individual and department daily, weekly, and monthly Key Performance Indicator goals as established by leadership
• Produce daily, weekly, and monthly productivity reports
• Accurately apply/correct contractual adjustment requests
• Accurately and timely resolve credit balances in assigned EPIC WQs
• Knowledge of payer specific programs and websites such as CMS pricer, GAMMIS, and FISS as required for job functions
• Clear and concise account document of credit resolution details

Productivity and Quality Assurance

• Entering clear and concise EPIC account notes
• Meet productivity standards as provided by leadership
• Provide supporting documentation with each refund request processed
• Accurate letters and envelopes with each refund request
• Accurate refund and adjustment requests
• Quality Assurance accuracy rate of or greater

Required Minimum Education and Experience

• High School Graduate
• Bachelor’s Degree (Preferred)
• 4 years healthcare related credit resolution experience

Required Minimum Skills

• Basic knowledge of medical terminology
• Basic experience and knowledge of PC applications
• Detail-oriented, good organizational skills, and ability to be self-directed
• Strong time management skills, managing multiple priorities and a heavy workload in a high-stress atmosphere
• Flexibility to perform other tasks as needed in an active work environment with changing work needs
• High-level problem solving, analytical, and investigational skills
• Excellent internal/external customer service skills
• Excellent communication skills to include oral and written comprehension and expression