Credit Processing Specialist, FT, Days, - Remote at Prisma Health

, Tennessee, United States -

Full Time

Start Date

Immediate

Expiry Date

29 May, 26

Salary

0.0

Posted On

28 Feb, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Data Analysis, Interpretation, Revenue Cycle, Account Analysis, Remittances, Denial Analysis, Non-Payment Analysis, Overpayment Analysis, Electronic Remittances, Government Payers, Coding Guidelines, Appeal Preparation, Credit Balance Review, HIPAA Compliance, Regulatory Requirements, Documentation

Industry

Hospitals and Health Care

Description

Inspire health. Serve with compassion. Be the difference. Job Summary Performs tasks of moderate to difficult complexity relating to physician and hospital accounts. Responsible for data analysis and interpretation throughout all functions of revenue cycle, analysis of aged accounts including remittances to determine 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, preparation of accounts for appeal, review/analysis of insurance credit balances and/or patient credits to include analysis/movement of unapplied, unidentified, undistributed balances. Moderate to difficult levels of evaluation, analysis, decision making required in these roles. Essential Functions All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference. Analyzes insurance and/or patient credit balances to determine root cause, takes action to resolve account. Contacts payer and makes hard inquiries on account status. Escalates problem account. Documents billing activity on the patient accounts according to departmental guidelines; ensures compliance with all applicable billing regulations and reports any suspected compliance issues to departmental leaders. Properly documents accounts clearly with indicators and activities so that tracking and trending can be prepared for further analysis. Ensures all work is compliant with privacy, HIPAA, and regulatory requirements. 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. Performs other duties as assigned. Supervisory/Management Responsibilities This is a non-management job that will report to a supervisor, manager, director or executive. Minimum Requirements Education - High School diploma or equivalent OR post-high school diploma / highest degree earned Experience - Two (2) years billing, bookkeeping, accounting experience In Lieu Of NA Required Certifications, Registrations, Licenses NA Knowledge, Skills and Abilities Knowledgeable of the job functions required for a Denial/Appeals Specialist, Payment Research Specialist and a Quality Assurance Specialist. Work Shift Day (United States of America) Location Blount Memorial Hospital Facility 7001 Corporate Department 70019935 System Billing Office Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.

Responsibilities

This role involves performing moderate to difficult tasks related to physician and hospital accounts, focusing on data analysis throughout the revenue cycle, including analyzing aged accounts for denials and overpayments. Responsibilities also include managing electronic remittances, handling government payer billing, correcting coding guidelines, preparing appeals, and analyzing/resolving insurance or patient credit balances.