Credit Resolution Escalation Specialist

Ventra Health, Inc.; Idaho; On-site; USD 42,000 - 64,000; Full time

Job summary

Ventra Health is seeking a Credit Resolution Escalation Specialist to monitor and resolve credit balances and refunds from billing system overages. Daily tasks are driven by a supervisor, with a plan to complete daily work lists while complying with billing laws and teamwork-focused service delivery nationwide.

The role emphasizes reviewing refund letters, identifying trends, and coordinating with Client Success and Finance to ensure proper approvals and clearance of credits.

Qualifications

• Must have knowledge of EOB statements.
• Experience posting insurance payments in a healthcare setting.
• Ability to read and interpret multiple insurance plans.

Responsibilities

• Process, research, and resolve credit balances and refunds from billing system escalated from Credit team.
• Review refund request letters and determine resolution per contract and guidelines.
• Identify trends and notify appropriate departments.
• Ensure that all check registers are sent to Client Success or finance for Approval.
• Ensure we receive all check numbers from Client to be uploaded into the system to ensure Credits can be cleared.
• Ensure all returned refund checks are researched and corrected.
• Analyze data from various reports and make recommendations accordingly.
• Performs special projects and other duties as assigned.

Skills

EOB knowledge

Insurance plans

Communication

MS Office

Math skills

Time management

Organization

Regulatory knowledge

Problem solving

Teamwork

Education

High School Diploma or Equivalent

Job description

About Us

Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, pathology, and radiology. Focused on Revenue Cycle Management, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities.

Come Join Our Team!

• As part of our robust Rewards & Recognition program, this role is eligible for our Ventra performance-based incentive plan, because we believe great work deserves great rewards

Help Us Grow Our Dream Team — Join Us, Refer a Friend, and Earn a Referral Bonus!

Job Summary

• The Credit Resolution Escalation Specialist is responsible for the monitoring and resolving Credit balances and refunds from billing system’s overages. Daily assignments are provided by the supervisor and the Credit Resolution Escalation Specialist must develop a plan to complete work lists by the end of each day. The Credit Resolution Escalation Specialists must comply with applicable laws regarding billing standards and be able to operate in a team-oriented environment that strives to provide superior service to our providers throughout the country.

Essential Functions and Tasks

• Processes, research, and resolves credit balances and refunds from a billing system’s overages that are escalated from the Credit team.
• Reviews refund request letters anddeterminesan appropriate resolutionbased on contract andtimelyguidelines.
• Identifiestrends and notifiesappropriate departments.
• Ensure that all check registers are sent to Client Success or finance for Approval.
• Ensure we receive all check numbers from Client to be uploaded into the system to ensure Credits can be cleared.
• Ensureall returned refund checks are researched and corrected.
• Analyze data from various reports and makes recommendations accordingly.
• Performs special projects and other duties as assigned

Education and Experience Requirements

• High School Diploma or Equivalent.
• Two (3)yearof experience posting insurance payments in a healthcare setting.
• Two (3) years of experience reading insurance Explanation of Benefits (EOB) statements preferred.

Knowledge, Skills, and Abilities

• Knowledge of Explanation of Benefits (EOB) statements.
• Knowledge of a variety of insurance plans.
• Strong oral, written, and interpersonal communication skills.
• Strong word processing,spreadsheet, and database software skills.
• Strong mathematical skills in addition, subtraction, multiplication and division of whole numbers and fractions; computing percentages; and working with decimal.
• Strong time management skills.
• Strong organizational skills.
• Ability to read, understand, and apply state/federal laws, regulations, and policies.
• Ability to take initiative and effectively troubleshoot while focusing on innovative solutions.
• Ability to remain flexible and work within a collaborative and fast paced environment.
• Ability to communicate with diverse personalities in a tactful, mature, and professional manner.

Compensation

• Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons.

• This position is also eligible for a discretionary incentive bonus in accordance with company policies.

Ventra Health

Equal Employment Opportunity (Applicable only in the US)Ventra Health is an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity and expression, or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities, as needed, to assist them in performing essential job functions.Recruitment AgenciesVentra Health does not accept unsolicited agency resumes. Ventra Health is not responsible for any fees related to unsolicited resumes.Solicitation of PaymentVentra Health does not solicit payment from our applicants and candidates for consideration or placement.

Attention CandidatesPlease be aware that there have been reports of individuals falsely claiming to represent Ventra Health or one of our affiliated entities Ventra Health Private Limited and Ventra Health Global Services.These scammers may attempt to conduct fake interviews, solicit personal information, and, in some cases, have sent fraudulent offer letters.To protect yourself, verify any communication you receive by contacting us directly through our official channels. If you have any doubts, please contact us at [e-mail] to confirm the legitimacy of the offer and the person who contacted you. All legitimate roles are posted on https://ventrahealth.com/careers/.

Statement of AccessibilityVentra Health is committed to making our digital experiences accessible to all users, regardless of ability or assistive technology preferences. We continually work to enhance the user experience through ongoing improvements and adherence to accessibility standards. Please review at https://ventrahealth.com/statement-of-accessibility/.