What are the responsibilities and job description for the Credit Resolution Specialist position at Childrens Hospital of The King's Daughters?
GENERAL SUMMARY
The Credit Resolution Specialist (CMG) 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 the Department Manager.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Maintains compliance for government payers by analyzing the account and taking the required action to resolve the credit.
Analyzes accounts 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 request claim submission for new payer.
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.
Must have 3 years of experience with third party payer insurance processes from verification, billing, coding and medical terminology.
Experience with credit resolution functions from investigation, review and determination.
Must demonstrate ability to effectively gather and exchange information via oral and written communications with proper grammar, spelling and punctuation.
Experience working in a high volume environment with specific deadlines to accomplish task.
Strong computer skills with experience utilizing MS Office suite.
WORKING CONDITIONS
Normal office environment with little exposure to excessive noise, dust, temperature and the like.
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