Credit Processing Specialist, FT, Days, - Remote

Prisma Health; Columbia (SC); On-site; USD 45,000 - 60,000; Full time

Job summary

Prisma Health seeks a Denial/Appeals Specialist who will perform data analysis on physician and hospital accounts within revenue cycle, focusing on denials, non-payments and overpayments. This role analyzes coded guidelines, prepares accounts for appeal, and reviews insurance credits and unapplied balances while ensuring compliance with HIPAA and billing regulations.

The position supports day shifts in the hospital revenue cycle, with responsibilities including account tracking, root-cause

Qualifications

• Two years billing, bookkeeping, or accounting experience.
• High School diploma or equivalent is required.

Responsibilities

• Analyze insurance and/or patient credit balances to determine root cause and resolve accounts.
• Document billing activity on patient accounts according to departmental guidelines and ensure compliance with regulations.
• Escalate problem accounts and report any suspected compliance issues to leadership.
• Ensure work complies with privacy, HIPAA, and regulatory requirements.
• Participate in general assignments and follow training and departmental procedures.

Skills

HIPAA compliance

Analytical thinking

Attention to detail

Education

High School diploma or equivalent

Job description

Inspire health. Serve with compassion. Be the difference.

Job Summary

Performs tasks of moderate to difficult complexity relating to physician and hospital accounts. Responsible for data analysis and interpretation throughout all functions of revenue cycle, analysis of aged accounts including 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 correct coding guidelines, preparation of accounts for appeal, review/analysis of insurance credit balances and/or patient credits to include analysis/movement of unapplied, unidentified, undistributed balances. Moderate to difficult levels of evaluation, analysis, decision making required in these roles.

Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference.
• Analyzes insurance and/or patient credit balances to determine root cause, takes action to resolve account.
• Contacts payer and makes hard inquiries on account status. Escalates problem account. 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. Properly documents accounts clearly with indicators and activities so that tracking and trending can be prepared for further analysis.
• Evaluates to ensure 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.

Supervisory/Management Responsibilities

• This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Requirements

• Education - High School diploma or equivalent OR post-high school diploma / highest degree earned
• Experience - Two (2) years billing, bookkeeping, accounting experience

In Lieu Of

• NA

Required Certifications, Registrations, Licenses

• NA

Knowledge, Skills And Abilities

• Knowledgeable of the job functions required for a Denial/Appeals Specialist, Payment Research Specialist and a Quality Assurance Specialist.

Work Shift

Day (United States of America)

Location

1205 Colonial Life Blvd W

Facility

7001 Corporate

Department

70019935 System Billing Office

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.