Refund Analyst

Job Description

ECU Health

About ECU Health Medical Center

ECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet® designation twice and provides acute and intermediate care, rehabilitation and outpatient health services to a 29-county region that is home to more than 1.4 million people.

Position Summary

• Research and resolve patient accounts with credit balances.
• Validate and process third party payer refund requests.
• Compiles and submits quarterly governmental credit balance reports.
• Stays current on rules and regulations affecting billing, reimbursement and submission of claims.
• Process correspondence received from third party payers and patients.
• Performs other related responsibilities as required or requested.
• Demonstrates service excellence.

Responsibilities

• Review and research patient accounts with credit balances. Contact third party payers, employers, state agencies and patients to help determine resolution. Evaluate documentation for posting or payment discrepancies. Initiate a refund or validate a corrected claim using billing software based on payer regulations and departmental policies and procedures. Recognizes and reports trends and potential problems with billing and posting issues that creates credit balances. Documents all actions taken.
• Validate all requests from third party payers for refund, ensuring they are legitimate in accordance to our contractual obligations and meet governmental requirements. Initiate refund within required timeframe. Documents all actions taken.
• Review credit balance data to identify accounts qualifying for the quarterly Medicare and Medicaid Credit Balance Report. Prepare reports as required by CMS and DMA regulations. Follow up with agencies to ensure the reports are received by the required due dates. Documents all actions taken.
• Reviews payer bulletins and websites for changes in rules and regulations. Interprets and incorporates changes into billing and collection activities. Attends educational seminars and meetings.
• Responds to all requests for documents required for timely claim resolution and prompt patient customer service.
• Performs in accordance with accepted procedure and responds to special requests by management in a timely and accurate manner.
• Adheres to the policies and procedures. Uses tact and courtesy in all interactions including but not limited to staff, patients and payers. Promotes a positive image and supports management in goals and objectives. Handles inquiries and complaints discreetly and effectively.

Minimum Requirements

• High School plus 2 years or more of formal training or education. Specify: Business or related
• 3 to 4 years experience. Reimbursement and/or billing knowledge, knowledge of financial reporting, experience researching unpaid and denied insurance claims, familiarity with secondary billing, appeals, and contractual adjustments. Patient Accounting, Insurance or Cash Applications. Previous experience in a physician or hospital business/billing office working with insurance companies.
• One year of related experience may be substituted for one year of education up to two years.

General Statement

It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant's qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.

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