Credit Processing Specialist, FT, Days, - Remote
About the Role
Performs tasks of moderate to difficult complexity relating to physician and hospital accounts. Responsibilities include data analysis and interpretation throughout all functions of the revenue cycle, analysis of aged accounts including remittances to determine reasons for denials, non-payment, and overpayment, posting/balancing/correcting electronic remittances, billing and follow-up of government payers and specialized accounts, analysis/correction of correct coding guidelines, preparation of accounts for appeal, and review/analysis of insurance credit balances and/or patient credits. This includes analysis/movement of unapplied, unidentified, undistributed balances.
Moderate to difficult levels of evaluation, analysis, and decision-making are required in this role.
Responsibilities
- Analyzes insurance and/or patient credit balances to determine root cause and takes action to resolve accounts.
- Contacts payers and makes hard inquiries on account status; escalates problem accounts.
- Documents billing activity on patient accounts according to departmental guidelines, ensuring compliance with all applicable billing regulations. Reports any suspected compliance issues to departmental leaders.
- Properly documents accounts with clear indicators and activities to enable tracking and trending for further analysis.
- Ensures all work is compliant with privacy, HIPAA, and regulatory requirements.
- Participates in general or special assignments and attends all required training.
- Adheres to policies and procedures as required by Prisma Health and follows all compliant regulatory payer guidance.
- Performs other duties as assigned.
Requirements
- High School diploma or equivalent OR post-high school diploma/highest degree earned.
- Two (2) years of billing, bookkeeping, or accounting experience.
Skills
Knowledgeable of the job functions required for a Denial/Appeals Specialist, Payment Research Specialist, and a Quality Assurance Specialist.
Schedule
Day shift