Credit Resolution Specialist
Childrens Hospital of The King's Daughters
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At a glance
Job overview
Childrens Hospital of The King's Daughters is hiring a Credit Resolution Specialist. The Credit Resolution Specialist monitors and resolves accounts in a credit status, ensuring compliance with government payers. This role involves analyzing accounts, confirming proper adjudication of charges, and verifying payment accuracy. The specialist utilizes various resources to determine credit reasons and takes necessary actions to resolve them, reporting to the department manager.
Key focus areas include Maintain compliance related to government payers by analyzing accounts and taking required action., Analyze accounts to determine the credit reason., and Utilize payer remits, payer websites, billing system, and other resources to determine reason and action..
Successful candidates bring High School Diploma, 1+ Years Credit Resolution, and Experience With Third Party Payer Processes. Important skills include Credit Resolution, Customer Service, Document Imaging, Third Party Payer Insurance Processes, Verification, and Billing.
Skills & qualifications
Skills
Qualifications
Full job description
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GENERAL SUMMARY
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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.
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ESSENTIAL DUTIES AND RESPONSIBILITIES
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Maintains compliance related to government payers by analyzing the account and taking the required action to resolve the credit.
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Analyzes account to determine the credit reason.
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Utilizes payer remits, payer websites, the billing system and other resources to determine the reason and action required.
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Ensures, if two payers are involved, the correct primary/secondary payment is on file for each payer.
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Updates insurance information based on new information obtained, and request claim submission for new payer.
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Enters and applies adjustments up to $1,000. Submits request for adjustments greater than $1,000 for approval and processing.
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Enters refunds to patient/parent/guarantor or payer up to $3,000. Submits request for refunds greater than $3,000 for approval and processing.
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Audits specified accounts in a credit status.
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Performs other duties as assigned.
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LICENSES AND/OR CERTIFICATIONS
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None required
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MINIMUM EDUCATION AND EXPERIENCE REQUIREMENTS
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High school diploma or equivalent required.
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Minimum of one year credit resolution, customer service and document imaging acquired in a hospital patient account department, physician office or medical services organization.
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Experience with credit resolution functions from investigation, review and determination.
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Must have experience with third party payer insurance processes from verification, billing, coding and medical terminology.
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Ability to effectively gather and exchange information in both oral and written communication with proper grammar, spelling and punctuation.
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Experience in working in a high volume environment with specific deadlines to accomplish task.
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Strong computer skills with experience utilizing MS Office suite required.
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WORKING CONDITIONS
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Normal office environment with little exposure to excessive noise, dust, temperature and the like.
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PHYSICAL REQUIREMENTS
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Click here to view physical requirements. (https://www.chkd.org/uploadedFiles/Documents/Employees/Category%20A%20Jobs.pdf)
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