Credit Resolution Specialist

Children's Hospital of The King's Daughters; Chesapeake (VA); On-site; USD 40,000 - 60,000; Full time

Job summary

An established industry player in healthcare is seeking a dedicated Credit Resolution Specialist to join their team. In this pivotal role, you will be responsible for monitoring and resolving accounts in credit status, ensuring accurate payment processing and compliance with government payers. This position requires strong analytical skills, attention to detail, and the ability to thrive in a high-volume environment. If you are passionate about making a difference in the healthcare sector and possess the necessary skills, this opportunity offers a chance to contribute significantly to patient account management in a supportive and professional setting.

Qualifications

• 1+ year experience in credit resolution and customer service.
• Strong computer skills with MS Office suite required.

Responsibilities

• Monitor and resolve accounts in credit status effectively.
• Analyze accounts and ensure proper payment processing.

Skills

Credit resolution

Customer service

Document imaging

Third party payer insurance processes

MS Office suite

Education

High school diploma or equivalent

Tools

Billing system

Payer remits

Job description

GENERAL SUMMARY
The Credit Resolution Specialist is responsible for monitoring and resolving accounts in a credit status assigned in their work queue. This role analyzes the account, confirms current charges have been properly adjudicated, and verifies that the payment by the payer and patient is accurate. Reports to department manager.

ESSENTIAL DUTIES AND RESPONSIBILITIES

1. Maintains compliance related to government payers by analyzing the account and taking the required action to resolve the credit.
2. Analyzes account to determine the credit reason.
3. Utilizes payer remits, payer websites, the billing system and other resources to determine the reason and action required.
4. Ensures, if two payers are involved, the correct primary/secondary payment is on file for each payer.
5. Updates insurance information based on new information obtained, and requests claim submission for new payer.
6. Enters and applies adjustments up to $1,000. Submits requests for adjustments greater than $1,000 for approval and processing.
7. Enters refunds to patient/parent/guarantor or payer up to $3,000. Submits requests for refunds greater than $3,000 for approval and processing.
8. Audits specified accounts in a credit status.
9. Performs other duties as assigned.

LICENSES AND/OR CERTIFICATIONS
None required.

MINIMUM EDUCATION AND EXPERIENCE REQUIREMENTS

1. High school diploma or equivalent required.
2. Minimum of one year credit resolution, customer service and document imaging acquired in a hospital patient account department, physician office or medical services organization.
3. Experience with credit resolution functions from investigation, review and determination.
4. Must have experience with third party payer insurance processes from verification, billing, coding and medical terminology.
5. Ability to effectively gather and exchange information in both oral and written communication with proper grammar, spelling and punctuation.
6. Experience in working in a high volume environment with specific deadlines to accomplish tasks.
7. Strong computer skills with experience utilizing MS Office suite required.

WORKING CONDITIONS
Normal office environment with little exposure to excessive noise, dust, temperature and the like.

PHYSICAL REQUIREMENTS
Click here to view physical requirements.