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Job Summary
The Credit Processing Specialist works under the immediate supervision of supervisors/managers in RevCycle performing tasks of moderate to difficult complexity relating to physician and hospital accounts. The specialist is responsible for data analysis and interpretation throughout all functions of the revenue cycle, including analysis of aged accounts, remittances to determine reasons for denials, non-payment and overpayment, post/balance/correct electronic remittances, billing and follow-up of government payers and specialized accounts, analysis/correction of coding guidelines, preparation of accounts for appeal, and review/analysis of insurance credit balances and/or patient credits.
Accountabilities
- Analyzes insurance and/or patient credit balances to determine root cause and takes action to resolve account. - 40%
- Contacts payer and makes inquiries on account status. Escalates problem accounts. Documents billing activity on the patient accounts according to departmental guidelines; ensures compliance with all applicable billing regulations and reports any suspected compliance issues to departmental leaders. - 20%
- Ensures all work is compliant with privacy, HIPAA, and regulatory requirements. - 10%
- Participates in general or special assignments and attends all required training. - 10%
- Adheres to policies and procedures as required by Prisma Health and follows all compliant regulatory payer guidance. - 10%
- Knowledgeable of the job functions required for a Denial/Appeals Specialist, Payment Research Specialist, and a Quality Assurance Specialist. Should be cross-trained and proficient to operate in any of these roles if the need arises. - 10%
Supervisory/Management Responsibilities
This is a non-management job that will report to a supervisor, manager, director, or executive.
Minimum Requirements
- High School diploma or equivalent OR post-high school diploma / highest degree earned
- 2 years of experience in billing, bookkeeping, or accounting
Work Shift
Day (United States of America)
Location
Colonial Life Building
Facility
7001 Corporate
Department
70019935 System Billing Office
Share your talent with us! Our vision is simple: to transform healthcare for the benefit of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.
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