Credit Resolution Specialist

5 days ago


Birmingham, Alabama, United States Conifer Health Solutions Full time
Job Summary

We are seeking a skilled Credit Resolution Representative to join our team at Conifer Health Solutions. As a key member of our Hospital Revenue Cycle Management team, you will be responsible for performing refunds and credit analyses functions.

Key Responsibilities
  • Perform 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.
  • Conduct Quarterly reviews for Medicare and Medicaid (based on state guidelines) and submit to client for approval, signature and submission.
  • Manage and maintain desk inventory, complete reports, and resolve high priority and aged inventory.
  • Accurately and thoroughly document 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.
  • Participate and attend meetings, training seminars and in-services to develop job knowledge.
Requirements
  • 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).
Education and Experience
  • High School Diploma or equivalent experience, preferred.
  • 1 - 3 years' experience in a hospital business environment performing billing and/or follow-up functions, preferred.
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.



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