Credit Resolution Representative-II (Hospital Claims) - PFS (Remote)

Job description

Employment Type: Full time Shift: Description: Hourly Pay Range: Min: $17.67 - $26.47 POSITION PURPOSE = Work Remote Position Performs day-to-day activities required to process credit account balances from patients and insurances within the Hospital and/or Medical Group revenue operations ($3-5B NPR) of a Patient Business Services (PBS) location. Serves as a member of a team at an assigned PBS location responsible for reducing patient balance account receivable credits and coordinating with the customer service team to communicate to patients regarding overpayments. Responsibilities require expertise in determining the root cause of credit balances and in taking the appropriate steps to resolve issues resulting in full adjudication of an account. Work activities include posting patient balance refunds and rebilling claims as needed to maintain manageable credit accounts receivable and to ensure accurate submission of claims and patient statements. This position reports directly to the Supervisor Payment Posting. ESSENTIAL FUNCTIONS Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions Performs daily activities of the Payment Posting team which reviews, monitors and performs follow up on patient credit accounts receivable as part of the revenue cycle process for an assigned PBS location Documents corrections regarding discrepancies created, and outstanding items and exceptions in appropriate systems regarding rejections and follow up activities performed in order to enable others to review claim history on all accounts. Tracks data on payment activity and findings for the Supervisor. Performs account adjustments or write-offs as needed in accordance with the Write-off- Policy. Researches credit balances caused by payment posting and prepares appropriate documentation. Serves as a back up to the Payment Posting Representatives. Prepares refund checks to patients and enters data into appropriate system. Performs duties in a manner which promotes accurate cash posting and reconciliation. Adheres to proactive practices, including cash posting of all incoming payments in a timely and effective manner. Performs processes related cash posting to ensure such activities are submitted timely, tracked, trended and reported to key stakeholders. Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Integrity and Compliance Program and Code of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior. MINIMUM QUALIFICATIONS High school diploma or Associate's degree in Accounting or Business Administration with at least two (2) years of experience and relevant knowledge of revenue cycle functions and systems within a hospital or clinic environment, a health insurance company, managed care organization or other health care financial service setting, performing medical claims processing, financial counseling, financial clearance, accounting, or customer service activities or an equivalent combination of education and experience. Some knowledge of health insurance and governmental programs, regulations, and billing processes, e.g., Medicare, Medicaid, Social Security Disability, Champus, Supplemental Security Income Disability, managed care contracts and coordination of benefits is highly desired. Experience in a complex, multi-site environment preferred. Experience with medical claims credit resolution working with all commercial and government payors needed Experience working with the Epic medical system highly desirable Proficient in Microsoft Office, including Outlook, Word, PowerPoint, and Excel. Excellent written and verbal communication skills and organizational abilities. Strong interpersonal skills in interacting with internal and external customers. Strong accuracy, attention to detail and time management skills. Completion of regulatory/mandatory certifications and skills validation competencies preferred. Must be comfortable operating in a collaborative, shared leadership environment. Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health. PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS This position operates in a typical office environment. The area is well lit, temperature controlled and free from hazards. Incumbent communicates frequently, in person and over the phone, with people in all locations on product support issues. Manual dexterity is needed in order to operate a keyboard. Hearing is needed for extensive telephone and in person communication. The environment in which the incumbent will work requires the ability to concentrate, meet deadlines, work on several projects at the same time and adapt to interruptions. Must be able to set and organize own work priorities and adapt to them as they change frequently. Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles. Must possess the ability to comply with Trinity Health policies and procedures. Performs day-to-day activities required to process credit account balances from patients and insurances within the Hospital and/or Medical Group revenue operations ($3-5B NPR) of a Patient Business Services (PBS) location. Serves as a member of a team at an assigned PBS location responsible for reducing patient balance account receivable credits and coordinating with the customer service team to communicate to patients regarding overpayments. Responsibilities require expertise in determining the root cause of credit balances and in taking the appropriate steps to resolve issues resulting in full adjudication of an account. Work activities include posting patient balance refunds and rebilling claims as needed to maintain manageable credit accounts receivable and to ensure accurate submission of claims and patient statements. This position reports directly to the Supervisor Payment Posting. Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.