5 120_PBS Cash Post_Credit Management Representative

Job Purpose

The Credit Management Representative is responsible for all elements of Credit Balance Management which include but is not limited to: Triaging patient and insurance credit balance to determine root cause, correcting contractual/manual adjustments, identifying overpayments and creating refund requests including appropriate documentation to support refund, identifying posting/payer trends and communicating to management for resolution.

Duties And Responsibilities

• Perform credit balance management for multiple clients
• Review daily credit balance work list to imitate research of credit balance accounts
• Research, identify root cause, and resolve patient accounts including but not limited to posting errors, insurance overpayments, patient overpayments, and/or system issues
• Prepare and submit refund requests as appropriate obtaining all pertinent back-up data including EOBs, insurance company correspondence, refund letter of explanation and explanation of reimbursement from practice management system.
• Correct all misapplied contractual adjustments
• Prepare spreadsheets for payers regarding special projects involving erroneous refunds and payer retractions
• Review payer refund request letters and take appropriate action to resolve and respond timely.
• Maintain WQ’s assigned to ensure accounts are worked in a timely manner.
• Identify trends and escalate to supervisor
• Adhere to unique client specific assigned workflows & tasks
• Collaborate effectively with co-source partners, and other functional teams supporting the business.
• Responsible for retrieving EOB’s to post payments & denials
• Uses the MCX workflow system, client host system, payer websites and other tools available
• Perform special projects and other duties as needed. Assists with special projects by utilizing excel spreadsheets, and the ability to communicate results.
• Meets and maintains daily productivity standards established in departmental policies
• Adheres to the policies and procedures established for the client/team
• Always maintain confidentiality
• Maintain a professional attitude
• Other duties as assigned by the management team
• Always understand and comply with Information Security and HIPAA policies and procedures
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
  
  

• High School diploma or equivalent required
• 1-year experience in insurance collections, credit balance management and or payment posting
• 1-3 years experience in Physician/Professional billing
• Working knowledge of the insurance follow-up process with the understanding of the fundamental concepts in healthcare reimbursement methodologies
• Understanding an EOB and what the remarks or denials mean
• Working knowledge of the insurance follow-up process with the understanding of the fundamental concepts in healthcare reimbursement methodologies
• Basic knowledge of healthcare claims processing including ICD-10, CPT, and HCPC codes
• Ability to work well individually and in a team environment.
• Proficiency with Microsoft Office
• Strong communication skills/oral and written
• Strong organizational skills
  
  

• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.