Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.

Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates.

The listed pay range or pay rate reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time).

Pay Range:

Scheduled Weekly Hours:

Position Overview

Performs all hospital and professional billing credit balance resolution tasks for insurance and other third-party payors to full completion as assigned by the Credit Balance Resolution Coordinator. Research credit balances, provides supporting evidence, communicates findings and performs billing system adjustment or other necessary actions to resolve credit balances. Prepares, submits, and ensures completion of refunds and retractions where appropriate to resolve credit balances

MINIMUM REQUIREMENTS
Education:    High school diploma or equivalent.
Experience:    One year experience in accounting, finance, or healthcare Revenue Cycle billing operations.
Other Credentials:    
Knowledge and Skills:    Possesses knowledge of Revenue Cycle billing functions, such as pre-bill edits, claim submission, accounts receivable or payment posting.
Special Training:    Experience working in excel. Experience as an end user in Epic, Athena, or Cerner preferred
Mental, Behavioral and Emotional Abilities:    Ability to take direction, work independently, and meet assigned deadlines. Research.
Usual Work Day:    8 Hours  
Reporting Relationships
Does this position formally supervise employees? No

If set to YES, then this position has the authority (delegated) to hire, terminate, discipline, promote or effectively recommend such to manager.

ESSENTIAL FUNCTIONS
Performs assigned tasks for all government, commercial, and special, contracted and non-contracted insurers, including other third-party payors to resolve credit balances
Takes direction and supports the Credit Balance Resolution Coordinator with communication and collaboration with billing and cash applications staff if needed
Research credit balances and provide supporting evidence, communicates findings and performs billing system adjustments or other necessary actions to resolve credit balances.
Prepares, submits, and ensures completion of refunds and retractions where appropriate to resolve credit balances. Performs billing tasks to resolve credit balances as assigned.
Reviews host billing systems, cash posting reports, EOBs, claims status documentation, payer portals, and communicates with insurance company customer service representatives for accurate research to determine the cause of credit balances.
Tracks and trends historical and current credit balance data to help identify potential future credit balance risks.
Routinely reviews credit balances to identify payment calculation variances with contracts, fee schedule, and claims where appropriate.
Reviews pre and post applied adjustments to the billing systems in accordance with daily, weekly, and monthly expectations for root cause analysis, corrections, and prevention.
Supports larger credit balance projects with payer documentation preparation and meeting participation (where needed).
Performs other duties as assigned.

PHYSICAL DEMANDS AND WORK ENVIRONMENT
Frequent physical demands include: Pinching/fine motor activities , Keyboard use/repetitive motion , Talk or Hear

Occasional physical demands include: Standing , Walking , Climbing (e.g., stairs or ladders) , Carry objects , Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Squat/kneel/crawl , Wrist position deviation

Continuous physical demands include: Sitting

Lifting Floor to Waist 15 lbs. Lifting Waist Level and Above 10 lbs.

Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Color Discrimination, Minimal Depth Perception, Minimal Hearing
Anticipated Occupational Exposure Risks Include the following: N/A
 

This position is eligible for the following benefits:

• Medical Plan

• Prescription drug coverage & In-House Employee Pharmacy

• Dental Plan

• Vision Plan

• Flexible Spending Account (FSA)

- Healthcare FSA

- Dependent Care FSA

• Retirement Savings and Investment Plan

• Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance

• Supplemental Group Term Life & Accidental Death & Dismemberment Insurance

• Disability Benefits – Long Term Disability (LTD)

• Disability Benefits – Short Term Disability (STD)

• Employee Assistance Program

• Commuter Transit

• Commuter Parking

• Supplemental Life Insurance

- Voluntary Life Spouse

- Voluntary Life Employee

- Voluntary Life Child

• Voluntary Legal Services

• Voluntary Accident, Critical Illness and Hospital Indemnity Insurance

• Voluntary Identity Theft Insurance

• Voluntary Pet Insurance

• Paid Time-Off Program

The pay range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level. 

The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria.