Credit Specialist - Professional Billing
About The Position
The Professional Billing Credit Specialist is responsible for the accurate and timely resolution of credit balances arising from professional services across five health systems, encompassing multiple specialties and over 50 practices. This role involves meticulous research, analysis, and processing of overpayments from patients and various payers within the EPIC EMR environment, ensuring compliance with all regulatory requirements and internal policies. The specialist plays a vital role in maintaining the financial integrity of our professional billing operations by minimizing outstanding credit balances and facilitating appropriate refunds.
Requirements
- In-depth knowledge of professional billing processes, CPT/HCPCS coding, modifier usage, and payer reimbursement methodologies.
- Advanced ability to navigate and utilize EPIC EMR for patient accounting, claim status, payment review, and documentation.
- Exceptional ability to analyze complex financial data, identify discrepancies, and develop effective solutions for professional billing credit balance issues.
- Strong understanding and adherence to federal, state, and local regulations, including Medicare, Medicaid, and commercial payer guidelines specific to professional billing.
- Excellent verbal and written communication for interacting with patients, payers, and internal teams.
- Meticulous accuracy in reviewing accounts, processing refunds, and documenting actions.
- Ability to manage a high volume of diverse accounts and prioritize tasks effectively across multiple entities.
- Proactive in identifying trends and suggesting enhancements to professional billing credit balance workflows.
- In-depth understanding of hospital revenue cycle operations, medical billing terminology, CPT/ICD-10 coding, and payer reimbursement methodologies (Medicare, Medicaid, commercial insurance).
- Exceptional analytical and problem-solving abilities.
- Strong attention to detail and accuracy.
- Excellent verbal and written communication skills.
- Proficiency in using patient accounting systems (e.g., Epic, Cerner, Meditech) and Microsoft Office Suite (Excel, Word).
- Ability to work independently and as part of a team in a fast-paced, high-volume environment.
- Strong organizational and time management skills.
- High school diploma or equivalent.
- Minimum of 3 years of dedicated experience in professional billing, with a strong emphasis on credit balance resolution and refund processing.
- Demonstrated experience working with EPIC EMR for professional billing.
Nice To Haves
- Proven ability to manage billing and credit processes for multiple health systems simultaneously is highly preferred.
- Associate's or Bachelor's degree in Business Administration, Finance, Healthcare Administration, or a related field.
- Experience managing professional billing and credit processes for multiple health systems, specialties, or a high volume of practices.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
