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Role Description
This role involves performing tasks of moderate to difficult complexity relating to both hospital and physician accounts.
- Handles a large volume of inbound calls and makes outbound calls related to self-pay follow up on accounts.
- Assists patients with requests for information, complaints, and resolving issues.
- Responsible for data analysis and interpretation throughout all functions of revenue cycle.
- Determines reasons for denials, non-payment, and overpayment.
- Post/balance/correct electronic remittances, billing, and follow-up of government payers and specialized accounts.
- Analysis/correction of correct coding guidelines and preparation of accounts for appeal.
- Review/analysis of insurance credit balances and analysis/movement of unapplied, unidentified, undistributed balances.
- Moderate to difficult levels of evaluation, analysis, and decision making required.
Qualifications
- High School diploma or equivalent OR post-high school diploma / highest degree earned.
- Two (2) years billing, bookkeeping, and/or accounting experience.
Requirements
- Knowledgeable of job functions required for various roles including A/R Follow-up Representative, Cash Posting Representative, Claims Clearinghouse Representative, Correspondence Representative, Credit Processing Specialist, Denial/Appeals Specialist, Payment Research Specialist, and Quality Assurance Specialist.
- Knowledgeable of the entire Revenue Cycle and Epic.
Benefits
- Participates in general or special assignments and attends all required training.
- Adheres to policies and procedures as required by Prisma Health and follows all compliant regulatory payer guidance.
Company Description
Prisma Health is the largest not-for-profit health organization in South Carolina, serving more than 1.2 million patients annually.
- Our 32,000 team members are dedicated to supporting the health and well-being of you and your family.
- Our promise is to: Inspire health. Serve with compassion. Be the difference.
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