Credit Resolution Specialist / Revenue Cycle

Children's Nebraska; Omaha (NE); On-site; USD 42,000 - 60,000; Full time

Job summary

Children’s Nebraska is seeking a Credit Resolution Specialist to analyze patient and insurance accounts, determine refunds, and ensure accurate postings. The role requires thorough research, payer coordination, and precise documentation to support efficient revenue cycle operations.

The position emphasizes HIPAA knowledge, EOB coding, and strong communication skills. Proficiency with Windows-based systems and independent work is important to support timely refunds and accurate financial records.

Qualifications

• Knowledge of HIPAA and healthcare regulations.
• Familiar with Explanation of Benefits coding and processing.
• Ability to communicate effectively both verbally and in writing.
• Experience with Windows-based systems and standard business software.

Responsibilities

• Analyze credit work queues to determine refunds.
• Research with payers and account holders to verify COB and financial details.
• Prepare and submit refund requests with documentation to Finance.
• Ensure accurate posting of refunds and reconcile with Finance.
• Process direct credit card refunds as needed.
• Maintain clear documentation of all transactions and resolutions.
• Scan and index correspondence into OnBase for record-keeping.

Skills

HIPAA knowledge

EOB coding

Communication

Windows OS

Independence

Stakeholder comms

Typing 45 wpm

Education

High School Diploma or GED

Job description

Job Description

Schedule: Monday- Friday, 8:00am - 5:00pm
At Children’s Nebraska, our mission is to improve the life of every child through exceptional care, advocacy, research and education. As the state’s only full-service pediatric healthcare center, we provide comprehensive, holistic care to our patients and families—from primary and specialty care to behavioral health services and everything in between. Dedicated to a People First culture, we foster an environment with joy, belonging, wellbeing, learning and growth. Turn your passion into purpose and make a difference where it matters most.

A Brief Overview

The Credit Resolution Specialist is responsible for analyzing patient and insurance accounts to ensure accurate refunds and adjustments. This role requires detailed research, coordination with payers and accountholders, and accurate documentation of financial transactions. The Credit Specialist ensures compliance with financial policies and contributes to the overall efficiency of the revenue cycle process.

Essential Functions

• Analyze accounts in credit work queues to determine if a refund is warranted.
• Conduct thorough research, including contacting payers’ third-party audit vendors and account holders to verify coordination of benefits and other financial details.
• Prepare and submit refund requests with appropriate documentation to the Finance department.
• Ensure accurate posting of refund entries to reconcile with what is received from Finance.
• Process direct credit card refunds as necessary.
• Meet productivity and accuracy requirements.
• Review associated adjustments related to refunds and post necessary reversals.
• Ensure accurate processing of undistributed and over-posted amounts.
• Review charges voided by the clinical team and collaborate with the coding team to determine if the charges should be reinstated and redistribute payments and adjustments as needed.
• Review accounts in credit work queues to resolve credits.
• Maintain clear and accurate documentation of all transactions and resolutions.
• Scan and index correspondence into OnBase for proper record-keeping and retrieval.
• Regular attendance at work is an essential function of the job.
• Perform physical requirements as described in the Physical Requirements section

Education Qualifications

• High School Diploma or GED equivalent Required

Experience Qualifications

• Minimum 2 years of experience with insurance AR Required

Skills And Abilities

• Knowledge of the current healthcare climate, including managed care developments, HIPAA standards and governmental program regulations.
• Knowledge of current coding practices regarding billing and processing of Explanation Of Benefits. Insure that proper reimbursement has been received.
• Ability to communicate effectively both verbally and in writing.
• The ability to use a Windows based computer system and common business software is desired.
• Must have the ability to work independently to effectively and efficiently perform assigned duties.
• Must be able to effectively communicate with physicians, hospital administrators, billing office staff, insurance carrier representatives, and the public in both verbal and written formats.
• Typing speed of 45 wpm.

Children’s is an equal opportunity employer, embracing and valuing the unique strengths and differences of people. We cultivate an inclusive environment of respect and trust where we all belong. We do not discriminate based on race, ethnicity, age, gender identity, religion, disability, veteran status, or any other protected characteristic.