Credit Resolution Specialist / Revenue Cycle

Children's Nebraska•Omaha, NE

About The Position

The Credit Resolution Specialist analyzes patient and insurance accounts to ensure accurate refunds and adjustments. The role involves detailed research, coordination with payers and accountholders, and accurate documentation of financial transactions. The specialist ensures compliance with financial policies and contributes to the efficiency of the revenue cycle process. The schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m. Regular attendance is an essential function of the job, and the role includes physical requirements described in a separate Physical Requirements section that was not provided.

Requirements

High school diploma or GED equivalent.
At least 2 years of experience with insurance accounts receivable.
Knowledge of the current healthcare climate, including managed care developments, HIPAA standards, and governmental program regulations.
Knowledge of current coding practices related to billing and processing explanations of benefits, and the ability to ensure proper reimbursement has been received.
Effective verbal and written communication skills.
Ability to work independently and perform assigned duties effectively and efficiently.
Ability to communicate with physicians, hospital administrators, billing office staff, insurance carrier representatives, and the public in verbal and written formats.
Typing speed of 45 words per minute.

Nice To Haves

Ability to use a Windows-based computer system and common business software is desired.

Responsibilities

Analyze accounts in credit work queues to determine whether refunds are warranted.
Research accounts, including contacting payers’ third-party audit vendors and account holders, to verify coordination of benefits and other financial details.
Prepare and submit refund requests with appropriate documentation to the Finance department.
Accurately post refund entries and reconcile them with amounts received from Finance.
Process direct credit card refunds as necessary.
Meet productivity and accuracy requirements.
Review adjustments related to refunds and post necessary reversals.
Accurately process undistributed and over-posted amounts.
Review charges voided by the clinical team and collaborate with the coding team to determine whether charges should be reinstated; redistribute payments and adjustments as needed.
Review accounts in credit work queues to resolve credits.
Maintain clear and accurate documentation of transactions and resolutions.
Scan and index correspondence into OnBase for record-keeping and retrieval.
Maintain regular attendance and perform the job’s physical requirements.