Credit Specialist

Essential Functions

• Research credit balances on patient accounts for both patient and payer

• Investigate each credit balance to determine if an over payment has been made

• Determine the correct course of action to resolve the refund request or credit balance which could include but not limited to:

Accurate completion of refund request for submission to refund department.
Requesting payment corrections or adjustment corrections as needed.
Requesting transfer of patient payments to other patient accounts that have patient balances that may reside in patient accounting system.

• Notify payor representative to initiate takeback (recoupment) and provide support documentation as required to the payor representative.

• Perform payment corrections or adjustment corrections, as needed

• Process ‘transfer of patient’ payments to other patient accounts with outstanding balances within the patient accounting system

• Ensures complete, accurate, and timely account notation and documentation in EPIC, including adjudication and credit balance refund processing.

• Prepare appropriate refund task in EPIC for payor/patient refund request received

• Review and follow up on refund/offset requests to ensure completion in a timely manner

• Contribute to workflow/ improvement processes for credit balances.

• Manage daily work queues of credit balances to ensure accounts are resolved timely

• Perform regular reconciliations of patient accounts to ensure accuracy and completeness

• Investigate and resolve any discrepancies or disputes related to patient accounts in a timely manner

• Ensure compliance with credit balance review processes

• Perform various clerical activities to support daily operations 

• Ensures compliance with all CHN and affiliate policies, as well as all state and federal regulations

• Demonstrates a commitment to CHN and Planned Parenthood’s mission related to health equity, especially centering racial equity, and deep sense of accountability to community

• Demonstrates a commitment to learning about and enhancing practices related to racial equity and the impact of structural racism on healthcare systems

• Provides positive and development feedback and accountability related to practices including, but not limited to, equity

The above duties and responsibilities are not an exhaustive list of required responsibilities, duties, and skills. Other duties may be added, and this job description can be amended at any time.

Qualifications and Experience (Required)

Minimum of 3 years of relevant account receivable experience  
A good understanding of the coordination of benefits
Experience in account inquiries and analysis to investigate and evaluate the payment methodology and accuracy, required
Clear understanding of contract terms, payer policy, and strong understanding of explanation of benefits
Strong analytical and problem-solving abilities 
Proficiency with Microsoft software (Excel, etc.) 
Demonstrated ability to maintain a customer-centric service approach in a fast-paced environment 
Excellent written and verbal communication skills and ability to collaborate and interact with all levels within and outside of CHN if necessary 
Strong attention to detail and follow-up; and ability to multi-task in fast-paced environment 
Demonstrated dedication to Planned Parenthood’s mission, vision, and values 
Strong interpersonal skills and the ability to build relationships with stakeholders 
Excellent time management, and problem-solving skills 

Qualifications and Experience (Preferred)

• Strong General Technology Skills: proficient utilization of Excel, Word, and Windows environment, Epic, eCW, NextGen or other practice management systems experience a plus
• Medical Billing and Coding certification, a plus

Key Requirements