Credit Analyst jobs in Delaware

30 Old Rudnick Ln

STATUS: Full Time 80 Hours

SHIFT:

GENERAL SUMMARY:

Summary:
This position is accountable for processing Provider Level Adjustments (PLBs) received from insurance companies for Hospital and Physician payments and offsets. Reconciles PLBs and other undistributed payment transactions to patient accounts for the Medical Center, Bayhealth Medical Group and Medical Alternative Care. Ability to understand the ANSI electronic remittance file structure, including loops and segments within the file to properly resolve the transaction. Responsible for researching and resolving posting related cash credit balances that are not related to contract or billing discrepancies. Responsible for researching and resolving cash undistributed clearing accounts and work queues. Responsible for researching and resolving PLB accounts. Responsible for reviewing undistributed and other payment error queues to maintain unapplied cash and reconciling items at a minimum.

ESSENTIAL FUNCTIONS & ACCOUNTABILITIES:

1. By payer, correctly process Provider Level Adjustments (PLBs), offsets and forward balances received and performs necessary system posting or transfer actions to properly adjudicate the payment. Ensures all transactions are appropriately balanced.
2. Resolves undistributed payments via the Cash Clearing work queues in a timely manner. Contact payers for any needed information to correctly post the payment and/or offset.
3. Submits refund requests for payments in an undistributed status (on PB Clearing account) as appropriate to resolve credit balances.
4. Responsible for supporting and communicating escheatment accounts per department policies.
5. Performs refund transactions in Epic (post approval) to complete the refund transaction.
6. Responsible for reconciling refund checks with Epic to complete refund process. Reviews and completes transaction to void all returned refund checks. Document account with reason for return and send documents to scanning for correspondence follow up.
7. Resolve SBO mailbox inquiries related to refunds, credits and undistributed payments.
8. All other duties as assigned within the scope and range of job responsibilities

REQUIRED MINIMUM EDUCATION AND CREDENTIAL:

EXPERIENCE:

Required: Three years experience in banking, bookkeeping or hospital and/or physician payment processing. Preferred: Five years experience in banking, bookkeeping or hospital and/or physician payment processing.

PREFERRED EDUCATION AND CREDENTIAL: