Credit Resolution Specialist

Description:

Position Summary:

The Credit Resolution Specialist is responsible for accurate and timely credit resolution for patient accounts and client invoices. The Specialist utilizes revenue cycle system reports, client invoices, and payer refund requests to determine the nature of the credit balance or appropriateness of the refund to resolve credits or process refunds. The Specialist adheres to Lifescan Labs payment posting, adjustment, credit balance, and refund standard operating procedures in addition to following government and insurance payer guidelines.


Essential Job Functions:

  • Analyzes account credit balances to identify action for account resolution. Utilizes system reports, researches payments, and analyzes accounts to resolve credit balances or generate refund.
  • Corrects or modifies system transactions to resolve credit balances or apply an insurance refund. Notates patient account of action taken.
  • Researches patient and insurance refund requests for appropriateness. Initiates refund with Finance or appeals refund request directly with payer.
  • Monitors clearing account credits and researches payment to identify correct patient account or determines if a refund is due. Process refunds as appropriate to resolve the unapplied payment.
  • Provides back up support during month end to support cash posting. Posts assigned remittance electronically and resolves unmatched payments manually. Utilizes the daily bank report to reconcile posted batches.
  • Assists with developing credit balance resolution and refund standard operating procedures for the cash applications team.
  • Meets or exceeds productivity and quality key performance metrics.
  • Supports Client Billing, AR Specialists, and Account Managers with refund questions and payment issues.
  • Researches unapplied payments timely by following up with the insurance payer or client. Logs unapplied payments on the daily bank report and updates report as cash is applied.
  • Assists with testing new features and functionality in the revenue cycle system related to cash applications.
  • Remains current with trends, regulatory requirements, and business strategies related to the payer relations and revenue cycle. Operates in compliance with all local, state, and Federal laws as well as policy and compliance standards.
  • Other duties and responsibilities as assigned.

Requirements:

Education and Experience:

  • Bachelor’s degree in healthcare, business, or finance preferred.
  • 4 – 5 years of experience in accounts receivable or cash applications within a revenue cycle or business office
  • 3 + years of experience with CMS1500 claims form and insurance payer explanation of benefits or 835 electronic transaction sets.
  • 2 – 3 years of experience working in revenue cycle applications to resolve patient accounts.

Supervisory Responsibilities:

N/A

Key Job Competencies:

  • Accounting and math skills.
  • Microsoft Office skills: Advanced Excel and proficiency in Power Point, and Word.
  • Exceptional detail orientation, critical thinking, analytical, and problem-solving skills.
  • Ability to analyze explanation of benefits, refund requests, and patient accounts.
  • Excellent verbal and written communication.
  • Must thrive in a high volume fast-paced environment.

Work Hours:Monday – Friday 9:00 a.m. – 5:30 p.m. CT

Location:Skokie, IL