Credit Research Specialist

Maintains detailed knowledge and skills related to commercial/government payor contract guidelines. Researches insurance and patient credit balances to ensure balance is accurate. Monitors payor performance, identifies trends, and reviews with Management. Initiates refunds/recoups within payor and corporate guidelines to insure compliance measures are maintained. Researches and coordinates all actions needed to resolve the outstanding credit balance.

• 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.
• Reports problems, questions or suggestions to immediate supervisor. Consistently follows departmental chain of command. Utilizes best practice processes around work assignments, project management, and quality of output while maximizing overall team performance.
• Researches all refund requests from insurance companies. Prepares refund packets for all insurance company requests. Pulls necessary payor EOB's and supporting data and mails to insurance companies in a timely manner, or as designated by the payer.
• Demonstrates a high skill for Payment Arrangement and/or cash collections, with an intimate knowledge of state and federal guidelines for collections, as well as knowledge of current Physician Business Services and Enterprise guidelines.

MINIMUM

High School Diploma / 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 Dignity Health Medical Group is the employed physician group of Dignity Health Arizona. Dignity Health Medical Group (DHMG) employs approximately 400 providers and 1200 support staff that cover a wide variety of specialties. The medical group has had tremendous success over the past few years and now provides more than 73 subspecialty services. The physicians provide clinical services in their areas of specialty and many serve in pivotal academic, research and leadership roles. DHMG is also heavily involved in preparing tomorrow's healthcare providers. DHMG has 84 medical school students and approximately 200 residents and fellows throughout the 25 academic programs. Clinical services are complemented with translational and bench research to augment medical education for residents and students. The mission of Dignity Health Medical Group is consistent with Dignity Health's mission and St. Joseph's guiding principles with a focus on innovative clinical care and the pursuit of excellence through scholarly activities. As part of the Dignity Health hospital system, DHMG has full access to the staff and all facilities on our hospital campuses. This unique relationship with our hospital allows Dignity Health Medical Group to provide its patients with state-of-the-art patient services including care of the poor and disenfranchised. Look for us on Facebook and follow us on Twitter. For the health of our community ... we are proud to announce that we are a tobacco-free campus