OCCUPATIONAL SUMMARY

Calculates and reconciles contractual adjustments that are required for all HMO, PPO, and contracted groups including Worker’s Compensation and Champus. Also responsible for submission of overpayments to the payers and for the notification of any patient overpayments.

PRIMARY DUTIES AND RESPONSIBILITIES

1. Reviews E.O.B. and remittance advices for contracted accounts to ensure the appropriate payment was received from the payer.
2. Determines contractual adjustments for those contracted accounts not adjusted at final bill by reviewing E.O.B./Remittals when payment is received.
3. Changes financial classes on accounts with patient liability balances, secondary insurance balances and account denials.
4. Controls money movements on the patient’s accounts to ensure that the correct balances are maintained at all times. Corrects any misapplied payments that occur.
5. Reviews and researches credit balances to determine if the credit is related to a patient or insurance overpayment and takes the appropriate action to resolve the credit.
6. Reviews account receivables and bad debt accounts for outstanding balances and makes the appropriate transfer.
7. Transfers misapplied payments to the appropriate accounts.
8. Prepares refunds, transfer adjustments, or other appropriate forms when necessary, and submits them to the supervisor for approval.
9. Practices proper safety techniques in accordance with hospital and departmental policies and procedures. Immediately reports any mechanical or electrical equipment malfunctions, unsafe conditions, or employee/patient/visitor injury‑accident to Manager.