Senior Patient Account Specialist – Credit Balance

🔥 15 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟠 Senior

👻 Ghost score 10%

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Emerus Holdings, Inc.

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2006

🏥 Healthcare

💊 Pharmaceuticals

💰 Private Equity Round on 2015-08

Healthcare • Pharmaceuticals

Emerus Holdings, Inc. is the nation’s first and largest operator of neighborhood hospitals, dedicated to partnering with leading health systems to deliver excellence, empathy, and innovation in healthcare. Their unique model features small-format hospitals that offer a wide range of outpatient and ancillary services, including emergency care, imaging, specialty care, inpatient care, diagnostic testing, and pharmacy services, all within a single licensed facility. Headquartered near Houston, Texas, Emerus prioritizes patient-first care and has been nationally recognized for its high standards. With a diverse team of over 2,000 professionals across 20+ specialties, Emerus has proudly served local communities for over 18 years, emphasizing collaboration and integration with partner health systems across the U. S.

📋 Description

• Assist the Patient Account Supervisor in managing patient and third-party payer payments • Resolve patient and third-party payer overpayments, credit balances, and refund requests • Research insurance benefits and coordination of benefits between payers • Distribute, reapply, or transfer payments to the appropriate date of service or account • Generate refund requests, overpayment notifications, or refund denials according to guidelines • Assign staff workloads and shift priorities as necessary • Monitor Credit Balance team activities for timely and appropriate reconciliation • Communicate with payers regarding overpayments, request recoupment, and void claims when necessary • Review, validate, and correct account adjustments based on reimbursement, coverage, contracted payers, and services provided • Validate and update patient demographics and insurance information • Initiate refunds to patients, guarantors, insurance companies, and other third parties • Verify benefits using online and telephone resources • Review refund and adjustment requests for accuracy and submit as necessary • Assist with workflow development and staff training • Work on special projects and ad hoc claim reviews assigned by leadership • Collaborate with CBO departments to resolve pending claim activities • Meet accuracy and productivity goals related to days in accounts receivable and cash collections • Attend required staff and company meetings • Perform additional assigned duties

🎯 Requirements

• High School Diploma or GED, required • 3+ years relevant experience in a provider inpatient or outpatient setting, required • Advanced knowledge of claims processing, appeals, medical terminology, accounts receivable, claim forms, claims billing, insurance verification, adjustments and refunds, claims status, and reimbursement • 2+ years previous Team Leader/Supervisory experience or equivalent, required • Advanced knowledge of all payer insurance groups, including Medicare, Medicaid and government managed care experience, required • Previous coaching and/or training experience and ability to create training manuals and training tools and materials, preferred • Experience with medical records or patient accounting systems, required • Knowledge and understanding of state and Federal payment laws to ensure prompt and accurate reimbursement, required • Advanced knowledge and understanding of healthcare explanation of benefits (EOBs), required • Intermediate knowledge of Microsoft Office products (Outlook, Excel, Word), including Excel vlookup/xlookup, pivot tables, and basic formulas, required • Fluency in English, written and oral communication

🏖️ Benefits

• Teamwork-focused work environment • Diversity, equity, and inclusion commitment • Equal access to information, development, and opportunity

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