Credit Research Specialist

As our Credit Research Specialist, you will maintain detailed knowledge and skills related to commercial and government payor contract guidelines.

Every day you will research insurance and patient credit balances to ensure accuracy, monitor payor performance, identify trends, and review findings with Management. You will also initiate refunds and recoups within payor and corporate guidelines to ensure compliance measures are maintained, and research and coordinate all actions needed to resolve outstanding credit balances.

To be successful in this role, you will meticulously manage credit balances, proactively identify trends in payor performance, and ensure strict adherence to all compliance guidelines for refunds and recoups.

• Meeting department established quality assurance percentage.
• Meeting department established productivity standards.
• Performs work via work files, and accurate action taken is assigned for each invoice upon completion.
• Researches and coordinates action as needed (e.g. refund, incorrect payment, payment posted to wrong account, calculation error) to patient and/or insurance company from patient accounts.
• Reads and interprets explanation of benefits (EOB) and demonstrated knowledge of a wide range of policies and procedures for the area.
• Contacts insurance companies when they are not compliant with contract terms in order to resolve issues/problems as they arise as related to overpayments. Integrates understanding of departmental issues and how related areas interact to achieve results.

Required

• High School Diploma or GED
• Two (2) years job related experience
• Knowledge of financial data analysis.
• Medicare and Medicaid regulations, third party reimbursement, charge and coding guidelines
• Proficient in aspects of reimbursement (i.e., benefit investigations, payer reimbursement policies, regulatory and administrative rules)
• Adept in physician and insurance reimbursement and billing concepts and procedures, as well as laws and regulations affecting payment compliance, denials and appeals recovery
• Understanding of medical coding systems effecting the adjudication of claims payment
• Proficiently utilizes MS Office applications, including MS Excel and MS Access

Preferred

• College level business courses 

Hello Humankindness

Where Your Passion Meets Purpose: Join Dignity Health Medical Group

Are you a healthcare professional who believes that every patient deserves not just treatment, but unwavering compassion? Do you envision a world where healthcare isn't just a service, but a fundamental right, delivered with integrity and innovation? If so, then Dignity Health Medical Group (DHMG) is where your career finds its true calling.

At Dignity Health Medical Group, you're not just filling a role; you're becoming an architect of healthier communities. We are the employed physician group of Dignity Health Arizona, and our success isn't just measured in numbers, but in the lives we touch and the advancements we champion.

Here's what sets us apart and why you belong with us:

• Impact that Resonates: You'll be part of a team delivering comprehensive clinical services, making a tangible difference in the lives of countless individuals. From cutting-edge diagnostics to life-changing treatments, your expertise will directly contribute to improved health outcomes.
• A Culture of Growth and Innovation: We don't just practice medicine; we advance it. 
• Shaping the Future of Healthcare: DHMG is deeply invested in preparing tomorrow's healthcare providers. We seamlessly blend clinical services with translational and bench research, creating a dynamic environment that augments medical education for residents and students. 
• Values-Driven Mission: We are united by a powerful set of principles. If you are deeply committed to social justice, health equity, and are prepared to deliver care in new, innovative ways, your values align perfectly with ours. We believe that everyone, regardless of background, deserves access to high-quality healthcare, and we actively work to make that a reality.
• A Supportive and Collaborative Environment: We believe in building a strong, inclusive team where everyone feels valued and respected.

Are you ready to transcend the ordinary and join a healthcare family where your skills are celebrated, your voice is heard, and your passion for healing finds its ultimate expression?

If you're eager to contribute to an organization that is making a profound difference, where innovation meets compassion, and where your commitment to social justice and health equity will be not just welcomed, but celebrated – then Dignity Health Medical Group is waiting for you.