Credit Resolution Specialist

Summary 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. Essential Duties and Responsibilities Maintains compliance related to government payers by analyzing the account and taking the required action to resolve the credit. Analyzes account to determine the credit reason. Utilizes payer remits, payer websites, the billing system, and other resources to determine the reason and action required. Ensures, if two payers are involved, the correct primary/secondary payment is on file for each payer. Updates insurance information based on new information obtained, and requests claim submission for new payer. Enters and applies adjustments up to $1,000. Submits request for adjustments greater than $1,000 for approval and processing. Enter refunds to patient/parent/guarantor or payer up to $3,000. Submits request for refunds greater than $3,000 for approval and processing. Audits specified accounts in a credit status. Performs other duties as assigned. Licenses and/or Certifications None required Minimum Education and Experience Requirements High school diploma or equivalent required. Minimum of one year credit resolution, customer service and document imaging acquired in a hospital patient account department, physician office or medical services organization. Experience with credit resolution functions from investigation, review and determination. Must have experience with third‑party payer insurance processes from verification, billing, coding and medical terminology. Ability to effectively gather and exchange information in both oral and written communication with proper grammar, spelling and punctuation. Experience working in a high‑volume environment with specific deadlines to accomplish tasks. Strong computer skills with experience utilizing MS Office suite required. Working Conditions Normal office environment with little exposure to excessive noise, dust, temperature and the like. Physical Requirements Click here to view physical requirements. Additional Information Equal Employment Opportunity is the Law - click here for more information Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, disability, gender identity, national origin, sexual orientation, veteran status, or any other status protected by federal, state, or local law. If assistance is needed, please reach out to us at View email address on click.appcast.io CHKDHS is an Equal Opportunity Employer. #J-18808-Ljbffr Children's Hospital of The King's Daughters