Credit Balance Refund Rep

Virginia Mason Franciscan Health has a rich history of providing exceptional healthcare, dating back to 1891. Building upon a legacy of compassionate care and innovation, our organization has evolved over the years through strategic partnerships and integrations to expand our reach and services across the Puget Sound area.

Today, as Virginia Mason Franciscan Health, we remain deeply committed to healing the whole person – body, mind, and spirit – in the communities we serve. This commitment is strengthened by the diverse expertise and shared values brought together through our growth.

Our dedicated providers offer a full spectrum of health care services, from routine wellness to complex disease management, all grounded in rigorous research and education. Our comprehensive network of 10 hospitals and nearly 300 care sites strategically located across the greater Puget Sound region reflects our ongoing commitment to accessibility and comprehensive care.

We are proud of our pioneering medical advances and numerous awards and accreditations that reflect our dedication to excellence. When you join Virginia Mason Franciscan Health, you become part of a team that delivers top-quality, professional healthcare in modern, well-equipped facilities, and contributes to a legacy of service built on collaboration and shared purpose.

Franciscan Medical Group, as part of Virginia Mason Franciscan Health, is currently looking for a full-time Credit Balance-Refund Rep for the fast-paced Franciscan Regional Billing Office in Tacoma, WA. Free parking and no weekends or organizationally recognized holidays required. 

Job Summary:

This job is responsible for facilitating the resolution of insurance and patient credit balances and issuing/requesting refunds as appropriate for patient satisfaction and compliance with applicable regulations.  Work includes responsibility for the timely and accurate resolution of all credit balance accounts and any action on accounts that result in unapplied activity.  

An incumbent researches accounts to determine whether: 1) a refund is appropriate to either the patient or the insurance company; 2) a payment transfer is needed; or 3) a reversal of contractual allowance or administrative adjustment is warranted.

Work requires an understanding of detailed billing requirements and insurance follow-up practices, as well as attention to detail, and the ability to accurately and timely troubleshoot/resolve (within scope of the position) resolution of refunds issues.

Essential Job Duties:

Reviews and analyzes accounts and/or reports from insurance companies and patients to facilitate the resolution of credit balance accounts.

• Reviews accounts and/or reports, including:  Explanation of Benefits (EOB)/ Electronic Remittance Advice (ERAs), payments, adjustments, insurance contracts and contracting system, insurance benefits, and all account comments; contacts and communicates with insurance companies to gather additional information, as necessary. 

• Refunds overpayments on accounts and transfers payments to the appropriate accounts.
• Verifies all patient account charges are billed to the insurance plan.
• Validates that insurance has paid correctly and identifies any patient responsibility.
• Conducts appropriate review to accurately transfer payments in accordance with established procedures.

Utilizes available resources to review payment discrepancies and identify trends/reasons for future discussion.   

• Proactively identifies, researches and resolves (with position scope) unusual, complex or escalated issues, as necessary.
• Notifies Supervisor/Manager of ongoing issues and concerns.

Documents all activities and findings in accordance with established policies and procedures; ensures the integrity of all account documentation; maintains confidentiality of medical records. 

• Adheres to refund approval protocols for non-routine refunds.
• Meets quality assurance and productivity standards through identification, reconciliation of credit balance accounts and review of credit balance reports for potential overpayments in accordance with organizational policies and procedures. 

Maintains current knowledge of internal, industry, and government regulations as applicable to assigned function.

• Applies knowledge of detailed billing requirements and insurance follow-up practices.
• Has knowledge of, and is compliant with, government regulations including "signature on file" requirements,   compliance program, HIPAA, etc.

Establishes and maintains professional and effective relationships with peers, payers and patients.

• Establishes and maintains a professional relationship with payers and FMG staff in order to resolve issues. 
• Depending on role and Epic training, may be called upon to support other areas in the Revenue Cycle.

Performs related duties as required.

Education/Work Experience:

• Two years of revenue cycle or related work experience that demonstrates attainment of the requisite job knowledge and abilities; OR  
• Post-high school education in a field (e.g. medical billing) that would demonstrate attainment of the requisite job knowledge/abilities may be substituted, on a month-for-month basis, for one year of the experience requirement.