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CREDIT SPECIALIST - (10518)

Universal Health Services


Location:
MALVERN, PA
Date:
12/07/2017
2017-12-072018-01-05
Job Code:
10518
Universal Health Services
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Job Details

Deltek Talent Management - CREDIT SPECIALIST - (10518)

Job Details


CREDIT SPECIALIST - (10518)

Facility Name
Independence Shared Services
Location
MALVERN, PA 19355 US (Primary)
Career Area
Support & Entry Level
Category
Billing
Job Description

The Credit Specialist is responsible for the accurate and timely resolution of the Practice Management System (PMS) self-pay and insurance credits.  Thoroughly researches credit balances to determine if an overpayment occurred and initiates the refund process accordingly outlining the reason for the refund and including explanation of benefits (EOBs), if needed.  Handles payer refund requests including validating the refund following review of the account history and submission of a refund request to Accounts Payable. Meets or exceeds established performance targets (productivity and quality) established by the their supervisor. Partners with the Reimbursement Specialists, as needed, to research accounts and validate self-pay and insurance refunds.   Maintains a working knowledge of CPT-4 and ICD-10 coding principles, government, managed care and commercial payers, payment posting, ERA processing, claim adjustment reason codes, contractual adjustment, copays, coinsurance and deductibles.  Demonstrates the ability to be an effective team player. Upholds “best practices” in day to day processes and work flow standardization to drive maximum efficiencies across the team. 

  • Accurate and timely resolution of the Practice Management System (PMS) self-pay and insurance credits as assigned by Billing Entity.  Conducts research of credit balances in PMS to determine if an overpayment occurred.  Initiates the refund process accordingly outlining the reason for the refund and including explanation of benefits (EOBs), if needed.    Meets or exceeds established performance targets (productivity and quality) established by the Billing Supervisor.
  • Reviews payer correspondence requesting refunds. Investigates the affected accounts included all payments applied to the account to determine if an overpayment has occurred.  Processes refund requests and forwards to Accounts Payable.
  • Effectively communicates with Reimbursement Specialists on credit trends related to Electronic Remittance Advice (ERA) processing to facilitate automated processing opportunities.  Partners with Reimbursement Specialists on complex accounts to ensure that a self-pay and/or insurance credit is an overpayment.
  • Maintains a working knowledge of CPT-4 and ICD-10 coding principles, government, managed care and commercial payers, payment posting, ERA processing, claim adjustment reason codes, contractual adjustment, copays, coinsurance and deductibles.
  • Identifies root causes and credit trends and works with the payer Customer Service Department or other appropriate individuals to mitigate additional credit account balances in PMS.   Escalates to the Supervisor, Billing to address at the payer Provider Representative level as needed.
  • Effectively prioritizes work assignment/s and demonstrates flexibility in assuming self-pay and insurance credit for Billing Entities assigned to other Credit Specialists to minimize lag days and ensure team goals/objectives are met.
  • Participates in regularly scheduled team meetings offering new paths, procedures and approaches to maximize opportunities for performance and process improvement.
  • Performs other duties as assigned.

 

Job Requirements

Education:  High School Graduate/GED required.  Technical School/2 Years College/Associates Degree preferred.

Work experience: Experience (3-5 years minimum) working in a healthcare (professional) billing, health insurance or equivalent operations work environment.   

Knowledge:  Healthcare (professional) billing, knowledge of CPT/ICD-10 coding, claim submission requirements, payment posting and remittance processing.  Understanding of the revenue cycle and how the various components work together preferred.

Skills: Excellent organization skills, attention to detail, research and problem solving ability.  Results oriented with a proven track record of accomplishing tasks within a high-performing team environment.    Service-oriented/customer-centric.  Strong computer literacy skills including proficiency in Microsoft Office.

Equipment Operated: Mainframe billing software (e.g., Cerner, Epic, IDX) experience highly desirable. 

If you meet the above requirements and are looking for a rewarding career, please take a moment to share your background with us by applying online.  Independence Shared Services offers competitive compensation commensurate with experience and benefit programs including medical, dental, life insurance, and 401(k).

Independence Shared Services is not accepting unsolicited assistance from search firms for this employment opportunity.  Please, no phone calls or emails.  All resumes submitted by search firms to any employee at IPM via email, the Internet or in any form and/or method without a valid written search agreement in place for this position will be deemed the sole property of Independence Shared Services.  No fee will be paid in the event the candidate is hired as a result of the referral or through other means.

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