Description
Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve.
Summary:
The Payment Posting Lead guides the daily activities of the Payment Posting Specialists. Provides assistance to teammates to resolve difficult accounts at Wayne UNC Health Care and accounts with credit balances according to Hospital Policy and regulatory, legal, and compliance guidelines. The Payment Posting Lead is responsible for understanding and keeping current with legal and regulatory rules related to credit balance accounts, including NC laws, Medicaid, Medicare, Liability, Worker's Compensation, HMO/PPO and Managed Care regulatory requirements, compliance guidelines and coordination of benefits rules.
Responsibilities:
1. Coordinates and organizes the daily activities of the Payment Posting Specialists.
2. Works overpayments, underpayments, and credits from Epic work queues.
3. Manages month-end payment posting and balancing activities.
4. Runs payment posting reports in Epic/Meditech.
5. Assists with the onboarding of new teammates and team training initiatives within the posting area.
6. Posts insurance and lockbox payments in Epic.
7. Posts patient payments in Meditech.
8. Updates general ledger with payment info.
9. Posts payments for cafeteria, gift shop, and other ancillary services in general ledger.
10. Resolves payment posting errors and discrepancies.
11. Audits payment posting activities and performs quality control activities.
12. Serves as a resource and role model to Payment Posting Specialists.
13. Resolves Credit Balances on all account types and all payors:
a. Determines that payment/adjustments are correctly posted.
b. Applies Coordination of Benefits (COB) rule.
c. Reviews guarantor accounts for possible transfer of overpayments.
d. Updates Collection Notes in each account for actions taken.
e. Generates refunds for requests with appropriate documentation.
14. Completes CMS 838 (Medicare and Medicaid credit balances report) quarterly and submits on time to Medicare and Medicaid. Resolves all Medicare and Medicaid credit balances by the end of the quarter, if possible.
15. Files adjusted claims to Medicare or Medicaid as required.
16. Assists Government and Non-government Specialists by providing guidance for complex billing and reconciliation tasks. Also provides guidance regarding resolving reimbursement issues in accordance with department procedures.
17. Coordinates and monitors External Credit Balance audit process for reviews of Credit Balance
Accounts.
18. Processes refunds to self-pay patient within specified timeframe under NC Law (currently within 45 days of the date of a credit balance).
19. For all refunds, the Payment Posting Lead reviews the account, i.e. the transactions and EOB's, then determines if the credit balance is a true credit balance or if a payment or transaction has been misapplied. If other debts exist, if applicable, will transfer the credit balance to the outstanding debt.
20. Researches and resolves special projects or issues with a focus on large, problematic payers;
proactively works with payers to prevent overpayments.
21. Identifies root causes for credit balances and takes appropriate steps to prevent future credit balances
22. Takes appropriate steps according to department policies to resolve credit balances, including but not limited to requesting a refund check or recoupment from the payer and adjustment of the balance, correcting contractual adjustment or other adjustments with correct debits and credits applied to each account, contacting the payor to verify COB or other information and request documentation to refund payer or that no refund is due and no COB exists.
23. Tracks refund requests, recoupment requests and adjustment requests.
24. Prepares credit balance statement detailing current and historic credit balances. Identifies trends, variances, aberrant data and other information as needed.
25. Participates in team meetings, training seminars and in-services to develop job knowledge. Shares knowledge with teammates proactively.
26. Provides input to 90 day and annual performance reviews.
27. Satisfies goals pertaining to productivity and quality expectations.
28. Promotes team morale.
WAYNE
Other information:
Education
High School graduate or equivalent required, additional coursework in accounting preferred.
Licensure/Certification
CRCR (Certified Revenue Cycle Representative) within one year of hire.
Experience
Minimum of three (3) years or more revenue cycle/business office experience required.
Knowledge, Skills and Abilities
• Strong working knowledge of credit balances, claims processing and accounts receivable processes required.
• Ability to analyze Explanation of Benefits (EOBs) as well as experience with ICD-10 coding and insurance terminology.
• Ability to interpret state and federal regulatory documentation.
• Experience working with electronic billing and A/R systems.
• Demonstrated success in appropriate and timely resolution of credit balance.
• Outstanding communication and customer service skills.
• Ability to lead, guide and motivate others.
• Ability to read, write and communicate effectively in English.
• Proficient with MS Office (Word, Excel and Outlook) and able to learn new software rapidly.
Valid NC Driver’s License: No
If driving a Wayne UNC Vehicle, must be 21 years old and MVR must be approved by Risk Management.
BO-204
01.8522.BO-204.NON-CLIN
Job Details
Legal Employer: Wayne Health
Entity: Wayne UNC Health Care
Organization Unit: Patient Accounts
Work Type: Full Time
Standard Hours Per Week: 40.00
Work Assignment Type: Onsite
Work Schedule: Day Job
Location of Job: WAYNE MED
Exempt From Overtime: Exempt: No
