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

Qualifications

• 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

Working Conditions

• 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.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.