Medical Billing Credit Resolution Specialist

Job Description

Job DescriptionDescription:

NO WEEKENDS, NO EVENINGS, NO HOLIDAYS

This position offers a hybrid remote option.

We offer competitive pay as well as PTO, Holiday pay, and comprehensive benefits package!

Benefits:

· Health insurance

· Dental insurance

· Vision insurance

· Life Insurance

· Pet Insurance

· Health savings account

· Paid sick time

· Paid time off

· Paid holidays

· Profit sharing

· Retirement plan

GENERAL SUMMARY

The Credit Resolution Specialist is responsible for investigation and resolution of credit receivable balances. This includes properly adjusting incorrect data entries or processing refunds when appropriate in alignment with management policies and procedures. The Credit Resolution Specialist is accountable for meeting or exceeding daily/weekly/monthly productivity targets set forth by management.

Requirements:

ESSENTIAL JOB FUNCTION/COMPETENCIES

The responsibilities and duties described in this job description are intended to provide a general overview of the position. Duties may vary depending on the specific needs of the affiliate or location you are working at and/or state requirements. Responsibilities include but are not limited to:

• Identifies and researches credit balances to separate true credits from false credits.
• Reviews patient and guarantor account(s) to ensure that a credit cannot be applied to an alternate balance on an account.
• Processes patient refunds in accordance with policies for true credits when appropriate.
• Corrects data entry errors that generated false credits and communicates trends to management.
• Follows established protocols for approval of refunds.
• Batches refunds and provides them to Finance department for processing as directed by management.
• Conducts regular follow-up on processing status of refunds with Finance.
• Addresses/resolves issues relating to patient accounts while noting account actions for complete audit trail of follow-up activity.
• Communicates with Payment Posting Specialist, Claim Resolution Specialist, and Business Office staff when necessary to resolve errors and clarify issues.
• Stays accountable to quality and productivity standards, and monitoring compliance with policies and procedures.
• Identifies process opportunity trends and recommend ways to improve efficiencies.
• Ensures adherence to third party and governmental regulations relating to coding, billing, documentation, compliance, and reimbursement.
• Participates in special projects, personal development training, and cross training as instructed.
• Informs Supervisor of trends, inconsistencies, discrepancies for immediate resolution.
• Works in conjunction with peers and functional areas of the Business Office department for the betterment of completing tasks and the company overall.
• Performs other position related duties as assigned.
• Employees shall adhere to high standards of ethical conduct and will comply with and assist in complying with all applicable laws and regulations. This will include and not be limited to following the Solaris Health Code of Conduct and all Solaris Health and Affiliated Practice policies and procedures; maintaining the confidentiality of patients' protected health information in compliance with the Health Insurance Portability and Accountability Act (HIPAA); immediately reporting any suspected concerns and/or violations to a supervisor and/or the Compliance Department; and the timely completion the Annual Compliance Training.

CERTIFICATIONS, LICENSURES OR REGISTRY REQUIREMENTS

• License and certification as required by state.

KNOWLEDGE | SKILLS | ABILITIES

• Demonstrates understanding of business and how actions contribute to company performance.
• Demonstrates excellent customer service skills.
• Knowledge of medical terminology, healthcare coding systems, and clinics functions.
• Experience in the use of CPT and HCPCS required.
• Utilizes Practice Management (PM) system and all other software systems in accordance with Business Office and/or management protocols.
• Reviews account information to identify trends, preventable root cause issues, and communicates these to Supervisor.
• Ability to follow policies and procedures for compliance, medical billing, and coding.
• Ability to type and enter data with proficiency and accuracy.
• Proven ability to manage multiple projects at a time while paying strict attention to detail.
• Ability to successfully meet departmental deadlines.
• Excellent verbal and written communication skills.
• Strong analytical and problem-solving skills.
• Customer-oriented with ability to remain calm in difficult situations.
• Skill in using computer programs and applications including Microsoft Office.
• Ability to work independently and manage deadlines.
• Complies with HIPAA regulations for patient confidentiality.
• Complies with all health and safety policies of the organization.

EDUCATION REQUIREMENTS

• High School Diploma or equivalent required.

EXPERIENCE REQUIREMENTS

• Minimum 2 years experience within a physician’s office or medical environment.
• Experience in Urology physician practice environment preferred.

REQUIRED TRAVEL

• N/A

PHYSICAL DEMANDS

Carrying Weight Frequency

1-25 lbs. Frequent from 34% to 66%

26-50 lbs. Occasionally from 2% to 33%

Pushing/Pulling Frequency

1-25 lbs. Seldom, up to 2%

100 + lbs. Seldom, up to 2%

Lifting - Height, Weight Frequency

Floor to Chest, 1 -25 lbs. Occasional: from 2% to 33%

Floor to Chest, 26-50 lbs. Seldom: up to 2%

Floor to Waist, 1-25 lbs. Occasional: from 2% to 33%

Floor to Waist, 26-50 lbs. Seldom: up to 2%