Credit Resolution Specialist / Revenue Cycle

Children's Hospital & Medical Center•Omaha, NE

6d•Onsite

About The Position

At Children’s Nebraska, our mission is to improve the life of every child through exceptional care, advocacy, research and education. As the state’s only full-service pediatric healthcare center, we provide comprehensive, holistic care to our patients and families—from primary and specialty care to behavioral health services and everything in between. Dedicated to a People First culture, we foster an environment with joy, belonging, wellbeing, learning and growth. Turn your passion into purpose and make a difference where it matters most. The Credit Resolution Specialist is responsible for analyzing patient and insurance accounts to ensure accurate refunds and adjustments. This role requires detailed research, coordination with payers and accountholders, and accurate documentation of financial transactions. The Credit Specialist ensures compliance with financial policies and contributes to the overall efficiency of the revenue cycle process.

Requirements

High School Diploma or GED equivalent
Minimum 2 years of experience with insurance AR
Knowledge of the current healthcare climate, including managed care developments, HIPAA standards and governmental program regulations.
Knowledge of current coding practices regarding billing and processing of Explanation Of Benefits.
Insure that proper reimbursement has been received.
Ability to communicate effectively both verbally and in writing.
The ability to use a Windows based computer system and common business software is desired.
Must have the ability to work independently to effectively and efficiently perform assigned duties.
Must be able to effectively communicate with physicians, hospital administrators, billing office staff, insurance carrier representatives, and the public in both verbal and written formats
Typing speed of 45 wpm.

Responsibilities

Analyze accounts in credit work queues to determine if a refund is warranted.
Conduct thorough research, 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.
Ensure accurate posting of refund entries to reconcile with what is received from Finance.
Process direct credit card refunds as necessary.
Meet productivity and accuracy requirements.
Review associated adjustments related to refunds and post necessary reversals.
Ensure accurate processing of undistributed and over-posted amounts.
Review charges voided by the clinical team and collaborate with the coding team to determine if the charges should be reinstated and redistribute payments and adjustments as needed.
Review accounts in credit work queues to resolve credits.
Maintain clear and accurate documentation of all transactions and resolutions.
Scan and index correspondence into OnBase for proper record-keeping and retrieval.
Regular attendance at work is an essential function of the job.