Credit Balance AR

Here at Savista, we enable our clients to navigate the biggest challenges in healthcare: quality clinical care with positive patient experiences and optimal financial results. We partner with healthcare organizations to problem solve and deliver revenue cycle improvement services that enable their success, support their patients, and nurture their communities, all while living our values of Commitment, Authenticity, Respect and Excellence (CARE).

The Credit Balance Resolution Representative is responsible for working with patients and third-party payers regarding payments made to professional and hospital accounts. The position handles a specific group of accounts (credit balance, undistributed payments, and requests for refunds) and ensures timely and accurate resolution. The position is responsible for working with internal and external customers (e.g., third party payers, patients/guarantors, estate representatives, attorneys, employers,) to facilitate the prompt resolution of credit balances or requests for refunds. 

This position is responsible for resolving accounts with credit balances which include insurance and patient overpayments, undistributed payments, and 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 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.

Essential Duties & Responsibilities:

• Responsible for credit balances, undistributed payments and requests for refunds

• Conducts timely and accurate review of undistributed payments, overpayments, credits and requests for refunds in the patient accounting system

• Responsible for taking all steps necessary to facilitate prompt and accurate resolution of payments including follow up with third party payers to determine coordination of benefits, insurance primacy rules and filing order.

• Effectively communicate information about insurance billing and follow-up processes to patients and internal customers

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

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

• Analyze data, identify issues, reach conclusions, and propose strategies for resolution of complex reimbursement issues.

• Determine the most effective repayment method based on payor processes, i.e. Manual Refund via Check, Resubmission of corrected claim, Payor Offset.

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

• Redistribute and/or transfer payments between multiple accounts of the same patient within the patient accounting system.

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

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

Internal Responsibilities:

• Adheres to all company policies and procedures including, but not limited to those identified within the Standards of Business Conduct and the Employee Handbook, as may be amended from time to time. Adheres to all applicable laws and regulations and the company's governance/compliance program.

• Responsible for reporting violations of the company's policies and procedures, Standards of Business Conduct, governance program, laws and regulations through the company's Help Line or other mechanism