Insurance Credits and Refunds Specialist

If you care about the opportunity to grow, to make a difference, to build a future and a life, then we just might have the career for you. Care to talk?

Bayhealth Medical Center is Central and Southern Delaware’s healthcare leader with hospitals in Dover and Milford, a s well as stand -alone Emergency Department in Smyrna and a hybrid E mergency Department and Urgent Care in Milton . We offer various practice settings throughout Kent and Sussex Counties. Bayhealth Medical Center Kent Campus is 90 minutes from Philadelphia, Washington, DC and Baltimore . Our Sussex Campus is 30 minutes to the Delaware beaches and relaxation in the sand!

Bayhealth Medical Center offers a competitive salary and comprehensive benefits package (for eligible positions) including:

Generous Paid Time Off and Paid Holidays

Matching 401(k)/403(b) Plans

Excellent Health, Dental, and Vision

Disability and Life Insurance options

On Site Child Care

Educational Reimbursement

Health Care and Dependent Care Flex Spending Accounts

Plus, an array of Voluntary Benefits to include Critical Care Coverage and more!

Location: 30 Old Rudnick Ln

Status: Full Time 80 Hours

Shift: Days

SALARY RANGE: 18.73 - 28.09 HOURLY

General Summary:

Responsible for reconciling patient accounts that remain in credit balance status due to overpayment, contract adjustment posting errors, and other issues. Follows proper control procedures for issuing refunds. Investigates and reports trends of issues which result in credit balances. Must be able to correctly interpret insurance contracts making adjustment or refund determinations with little to no assistance.

Responsibilities:

1. Responsible for researching accounts in a credit balance status and taking the necessary steps to resolve the credit balance. Review remittance advice and other correspondence to correct account balance and/or identify refunds due. Calls payers as appropriate to obtain additional insight into claim processing and payment amount(s). Document outcome of research and actions taken to resolve the credit balance.

2. Correctly interprets Federal and State regulations for Medicare and Medicaid and contract terms for Managed Care, Commercial, and Workers Compensation as applicable to ensure all income is appropriately recorded.

3. Follows proper control procedures and departmental policy for posting necessary contractual, small balance and/or refund adjustments. Timely and accurate submission of adjustments and refund requests for approval based on departmental approval guidelines.

4. Identifies trends and coordinates with SBO Cash Application staff to reduce the volume of credit balance accounts generated from posting activities in the future.

5. Prioritizes work to ensure department and corporate goals are met.

6. Maintains productivity standards and credit balances less than the value of 1 day of average daily revenue.

7. All other duties as assigned within the scope and range of job responsibilities

Required Education, Credential(s) and Experience:

Education: High School Diploma or GED

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Credential(s): None Required

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Experience:

Required: Three (3) years’ experience in hospital billing/collections and/or Banking related collections experience.

Preferred: Four (4) years’ experience in hospital billing/collections and/or Banking related collections experience.

Preferred Education, Credential(s) and Experience:

Education: Associate Degree

Credential(s): Certified Revenue Cycle Specialist

Experience:

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