Credit Senior Representative

JOB SUMMARY 

Responsibilities include the compliant review and analysis of credit balance accounts to determine cause of credit balance and resolution of same. Responsible for thorough and accurate follow up and communication with facilities, management, Insurance companies and patients. In addition, the Senior Credit Resolution representative will act as an escalation point for credit balance representative questions, training, assist with job aid creation, and escalate system and payer issues/trends.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Performs refund and credit analysis on escalated, complex, high dollar and aged inventory.           
• Responsible for timely submission of all identified overpayments and handle any escalations needing approval
• Review all incoming escalated payer refund demand requests via written or verbal
• Responds to patient inquiries and Insurance phone calls regarding account balances and refunds
• Interacts with facilities, management, and other Conifer departments to resolve accounts
• Responsible for QA of the prepared Credit Balance Quarterly Report prior to submission and tracking of all submitted reports through processing completion.

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Advanced understanding of Hospital Revenue Cycle
• Advanced understanding of Medicare and Medicaid regulations preferred
• Advanced understanding of contracted, commercial, W/C, and other government payers
• Advanced understanding of claims cycle process with payers
• Advanced understanding of insurance reimbursement rates and patient responsibility
• Advanced understanding of Payer remits
• Advanced understanding of Microsoft Office 
• Advanced ability to handle large volume with excellent quality
• Advanced oral and written communication skills required

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment.  This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

• HS Diploma or equivalent, required 
• AA degree, preferred
• 3-5 years in a Hospital Patient Financial Services department

PHYSICAL DEMANDS 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.              

• Must be able to work in sitting position, use computer and answer telephone

WORK ENVIRONMENT 

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

• Cheerful, pleasant, remote private setting for telecommuting, ability to work independently

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

 

No. Description % of Time

1.  

Performs refund and credit analysis on escalated, compl