Credit Reconciliation Representative I

Major Responsibilities

• Analyze and resolve credit balances and refund requests within Advocate Health Hospital and Professional Billing entities, ensuring appropriate contract reimbursement rates are applied.
• Utilize multiple systems to review and resolve credit balances accurately.
• Determine the payor responsible for overpayment, verify benefits coordination, reimbursement calculations, and payment sources, and follow system processes and department procedures.
• Identify and report root causes of credit balances and payer refund trends, collaborating with internal and external counterparts.
• Document all actions taken to resolve credit or refund requests in patient and guarantor account notes.
• Possess knowledge of refund/adjustment processes and utilize systems/applications proficiently to resolve credit balances and process refunds.
• Contribute to improvement initiatives and department/system goals.
• Adhere to Advocate Health Revenue Cycle policies, procedures, guidelines, and productivity standards, maintaining personal growth and development.
• Assist Level II staff with ad hoc projects and related job activities to support department operations, including patient accounting activities during high volume periods or impending deadlines.

Knowledge, Skills & Abilities

• Good organizational ability and communication skills (written and verbal).
• Ability to read, enter and retrieve information from multiple patient accounting systems.
• Basic understanding of Microsoft Office.
• Basic bookkeeping skills and a strong mathematics aptitude.
• Able to work independently, under pressure in a fast-paced environment.
• Strong attention to detail and maintains a high degree of accuracy.
• Managed Care payer contract terms and Medicare/Medicaid payer guidelines.
• Ethical conduct.

Physical Requirements And Working Conditions

• Must be able to sit the majority of the workday.
• Exposed to a normal office environment.
• Operates all equipment necessary to perform the job.