Job Summary

Our client is seeking a Credit Balance Specialist responsible for analyzing reimbursement, processing audits, and refunding overpayments. The specialist will ensure compliance with CMS guidelines and facilitate communication with payers to resolve credit balances effectively.

Key Responsibilities

• Analyze all applicable explanation of benefits (EOBs), Managed Care, and Governmental reimbursement using the contractual adjustment system to determine if accounts have been overpaid.
• Register and facilitate the reporting and refund to Medicare of overpayments quarterly according to CMS reporting guidelines.
• Process and respond timely to all audit findings and refund requests from payers to avoid inaccurate recoveries.
• Draft overpayment and denial letters to resolve/dispute claims of overpayments.
• Monitor, research, and record all returned refund checks (voids/stale date).
• Resolve credit balance audits, refund requests, daily credits created, and complex debit balance audits timely and accurately.
• Issue refunds to federally-funded payers such as Medicare, Medicaid, or CHAMPUS/Tricare.
• Exhibit competency in the utilization of hospital based PC accounting system.
• Maintain necessary logs and monthly performance standards to assure department goals are met.
• Perform all essential functions included in Credit Balance Resolution Analyst position.
• Maintain reasonably regular, punctual attendance consistent with client policies, ADA, FMLA, and other federal, state, and local standards.
• Maintain compliance with all client policies and procedures.

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.