Title: Credit Specialist
Department: Revenue Cycle Management
Reports to: Manager, Reimbursement/ Director, Reimbursement
Perform duties to process medical billing and credit collections with focus on accuracy timeliness and adherence to process. Reduce DSO, recognize additional revenue opportunities, and improve in credit collection rates, while working within the limits of standard or accepted practice.
* Review patient files for completeness and accuracy, identify and audit claims, ensure all revenue opportunities are included.
* Review documents received including Explanations of Benefits (EOBs), Remittance Advices (RAs) and other documents indicating credit balances. Identify reasons for credits, take required corrective action, and take ownership of claims through to timely, successful resolution.
* Analyze credits, identify trends and recommend process improvement opportunities that will result in credit DSO reduction, superior credit rate and intervals and simplified processes that are responsive to the requirements of specific payers.
* Review claims with outstanding credit balances and identify actions to successfully resolve. Follow up with insurers and patients to resolve outstanding balances in an environment of excellent customer service focused on building enduring customer and business relationships.
* Document case activity, communications and correspondence in computer system to ensure completeness and accuracy of account activity and actions taken to resolve outstanding claims issues.
* Contribute medical claims expertise to the design of training and knowledge transfer programs, materials, policies and procedures to improve the efficiency and effectiveness of the Revenue Cycle Management team.
* Perform or assist with any departmental projects or operations, as required to maintain workflow and to meet schedules and quality requirements.
* Participate in any variety of meetings and work groups to integrate activities, communicate issues, obtain approvals, resolve problems and maintain specified level of knowledge pertaining to new developments, requirements, and policies.
* Perform other related duties as assigned.
We are an equal opportunity employer and make hiring decisions based on merit. Recruitment, hiring, training, and job assignments are made without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, or any other protected classification. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.
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