Credit Resolution Specialist: Payer Account Expert

CHKD Medical Group; Norfolk (VA); Hybrid; USD 38,000 - 54,000; Full time

Job summary

CHKD Medical Group in Norfolk, VA is seeking a Credit Resolution Specialist to monitor and resolve accounts in credit status. The role analyzes accounts, verifies payer and patient payments, and ensures proper adjudication of current charges.

Responsibilities include maintaining compliance with government payers, identifying credit reasons, using payer remits and billing systems, and processing adjustments and refunds within approved limits.

Qualifications

• High school diploma or equivalent required.
• Minimum of one year credit resolution, customer service and document imaging in a hospital patient account setting.
• Experience with third party payer insurance processes (verification, billing, coding, medical terminology).
• Ability to communicate effectively in oral and written form with proper grammar and punctuation.
• Experience in a high-volume environment with deadlines.
• Strong computer skills and proficiency with MS Office.

Responsibilities

• Monitor and resolve accounts in credit status in workload queue.
• Analyze accounts to determine credit reason and ensure proper adjudication of current charges.
• Use payer remits, payer websites, the billing system and other resources to determine actions.
• Ensure correct primary/secondary payment when two payers are involved.
• Update insurance information and request claim submissions for new payers.
• Enter adjustments up to $1,000; seek approval for amounts over $1,000.
• Enter refunds to patient/parent/guarantor or payer up to $3,000; seek approval for amounts over $3,000.
• Audit specified accounts in a credit status.
• Perform other duties as assigned.

Job description

CHKD Medical Group in Norfolk, VA is seeking a Credit Resolution Specialist to monitor and resolve accounts in credit status. The role analyzes accounts, verifies payer and patient payments, and ensures proper adjudication of current charges.

Responsibilities include maintaining compliance with government payers, identifying credit reasons, using payer remits and billing systems, and processing adjustments and refunds within approved limits.