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Credit Resolution Representative

2 months ago

Birmingham, United States Conifer Health Solutions Full time
Job Description

JOB SUMMARY

Responsible for performing the refunds and credit analyses functions within the Hospital Revenue Cycle Management team.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.
  • Performs refund and credit analyses, audit and reimbursement functions for all Managed Care, Commercial, Medicare, Medicaid, Self-pay and third party payors for all patient accounts. Determines if credit balance is an over contractual, late charges applied, overpayment etc. to ensure appropriate actions are taken to resolve.
  • Performs Quarterly reviews for Medicare and Medicaid (based on state guidelines) and submits to client for approval, signature and submission.
  • Manage and maintain desk inventory, complete reports, and resolve high priority and aged inventory Accurately and thoroughly documents the pertinent credit balance review activity performed.
  • Communicate issues to management, including payer, system or escalated account issues.
  • Handle correspondence received from payers and patients requesting refunds. Respond timely to emails and telephone messages as appropriate
  • Participate and attend meetings, training seminars and in-services to develop job knowledge.
  • Other duties as assigned by Management.
KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • Entry level understanding of hospital billing form requirements (UB04 and HCFA 1500)
  • Entry level knowledge of ACE/PBAR/STAR/Meditech or EPIC preferred
  • Entry level knowledge of ICD-10, HCPCS/CPT coding and medical terminology
  • Entry level writing skills
  • Contract Interpretation skills greatly preferred
  • Understanding and interpretation of Managed Care contracts
  • Understanding of Gov't Medicare and multiple state Medicaid programs payor regulations (if Gov't team)
Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.
  • High School Diploma or equivalent experience, preferred.
  • 1 - 3 years' experience in a hospital business environment performing billing and/or follow-up functions, preferred.
PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • Ability to sit and work at a computer terminal for extended periods of time
WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • Call Center environment with multiple workstations in close proximity.
  • Some positions may be eligible for Telecommuting based off Business need or position function. If eligible, all Telecommuting guidelines must be adhered to at all times.
As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step

Responsibilities

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

No. Description % of Time Performs refund and credit analyses, audit and reimbursement functions for all Managed Care, Commercial, Medicare, Medicaid, Self-pay and third party payors for all patient accounts. Determines if credit balance is an over contractual, late charges applied, overpayment etc. to ensure appropriate actions are taken to resolve. 30 Performs Quarterly reviews for Medicare and Medicaid (based on state guidelines) and submits to client for approval, signature and submission. 30 Manage and maintain desk inventory, complete reports, and resolve high priority and aged inventory Accurately and thoroughly documents the pertinent credit balance review activity performed. 15 Communicate issues to management, including payer, system or escalated account issues. 10 Handle correspondence received from payers and patients requesting refunds. Respond timely to emails and telephone messages as appropriate 5 Participate and attend meetings, training seminars and in-services to develop job knowledge. 5 Other duties as assigned by Management. 5

Qualifications

KNOWLEDGE, SKILLS, ABILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • Entry level understanding of hospital billing form requirements (UB04 and HCFA 1500)
  • Entry level knowledge of ACE/PBAR/STAR/Meditech or EPIC preferred
  • Entry level knowledge of ICD-10, HCPCS/CPT coding and medical terminology
  • Entry level writing skills
  • Contract Interpretation skills greatly preferred
  • Understanding and interpretation of Managed Care contracts
  • Understanding of Gov't Medicare and multiple state Medicaid programs payor regulations (if Gov't team)
Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
  • High School Diploma or equivalent experience, preferred.
  • 1 - 3 years' experience in a hospital business environment performing billing and/or follow-up functions, preferred.
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Ability to sit and work at a computer terminal for extended periods of time
WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • Call Center environment with multiple workstations in close proximity
  • Some positions may be eligible for Telecommuting based off Business need or position function. If eligible, all Telecommuting guidelines must be adhered to at all times.