Credit Specialist

Role Description

Under general supervision, is responsible for the comprehensive analysis of payor and patient accounts with credit balances. Coordinates the timely resolution of invoices with overpayments, misapplied cash, and overstated adjustments. Reviews refund and recoupment requests, initiates return of funds and/or rebuttals of the requests. Follows standard procedures and pre-established guidelines to complete tasks. Supports and adheres to The US Oncology Compliance Program, to include the Code of Ethics and Business Standards, and The US Oncology’s Shared Values.

Responsibilities

• Researches each credit to determine cause of credit balance and subsequent steps for resolution.
• Ensures codes are accurate and sequenced correctly in accordance with government and insurance regulations.
• Initiates payor resolutions, including but not limited to: refund check request, recoupment request, adjustment/write off request, transfer of cash.
• May be responsible to research and resolve any electronic claim/payor edits within 24 hours of exception.
• Initiates patient resolutions, including but not limited to: refund check request, refund credit card request, adjustment/write off request, transfer of cash.
• Manages correspondence requests for refunds and recoupments, either initiating funds return or dispute of request.
• May answer questions and resolve complaints.
• Documents conversations with payors in the PMS Contacts and follows up with clinic or any missing or incomplete documentation.
• Researches and responds to routine account inquiries and takes appropriate action; escalates non-routine issues, makes recommendations for solutions to unique situations.
• Identifies processes and procedures to improve efficiencies.
• Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regards to patient’s records and collections.
• Other duties as requested or assigned.

Qualifications

• High school diploma or equivalent required.
• Associates degree preferred.
• Position requires three (3) years revenue cycle or equivalent experience.
• Proficiency with computer systems and Microsoft Office (Word and Excel) required.

Requirements

• Physical demands include being present at the employee site during regularly scheduled business hours.
• Regularly required to sit or stand and talk or hear.
• Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination.
• Requires standing and walking for extensive periods of time.
• Occasionally lifts and carries items weighing up to 40 lbs.
• Requires corrected vision and hearing to normal range.

Work Environment

• Exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations, and other conditions common to an oncology/hematology clinic environment.
• Work will involve in-person interaction with co-workers and management and/or clients.
• Work may require minimal travel by automobile to office sites.

Benefits

• M/D/V, Life Ins., 401(k)