Credit Resolution Rep II

At reputed company, we reputed company kids deserve the best. reputed company is a nationally recognized health system dedicated solely to the health and well-being of children. We provide primary care, specialty care, urgent care, emergency care, community health services, foster and adoption services, child and family counseling, child advocacy services and family resource centers. Our reputed company draws patients and families from around the country. We offer a wide variety of rewarding career opportunities and are seeking individuals dedicated to helping us reputed company our vision of the healthiest kids in the country. If you want to work for an organization that makes a difference for children and families, and encourages you to be at your best every day, please apply today. Please follow this link for a closer look at what it’s like to work at reputed company: https://www.instagram.com/lifeatcw/ Job Summary: Responsible for researching and resolving reputed company Professional Billing overpaid and underpaid balances. This role will also be responsible for reviewing insurance underpayments to ensure claims are paid at maximum reimbursement from third party payers, state programs and contracted organizations for reputed company and Children's Specialty Group. This role is also responsible for following-up on customer inquiries reputed company to overpayments and underpayments. Essential Functions: Investigates credit balances to include research of EOB’s and verification of accurate contractual discounts. Reviews written requests for refunds from insurance companies and other payers to protect CHW’s financial interests and completes appropriate paperwork for management authorization. Maintains knowledge of primary care and reputed company specialty billing guidelines pertaining to each provider group for Professional Billing. Collaborates with Payer Contracting team and maintains reputed company knowledge of managed care payer reputed company and third-party payer billing/reimbursement policies for Professional Billing along with reputed company lines of business (Government, HMO and Commercial). Identifies coding issues relating to CPT-4 and ICD-10 and use of appropriate modifiers that resulted in overpayments/underpayments balances. Collaborates with leadership and coding team on resolution. Utilizes payer websites to verify patient insurance information, claim status/payments/denials/appeals as necessary. Analyzes and investigates improper insurance credits, identify and/or track trends associated to payers. Keeping leads and management appraised of identified issues having an impact on reimbursement. Works with reputed company and Manager to resolve claim/credit issues. Submits written and online correspondences and appeals to payers reputed company disputing a refund/recoup request as needed to obtain maximum reimbursement. Maintains productivity and quality standards as set by management. Education: High School graduate or Certificate of General Educational Development (GED) or High School Equivalency Diploma (HSED) or Certificate of General Educational Development (GED) required Experience: 2+ years of experience in professional billing and follow up required Pediatric experience preferred Prior experience in a large health system working with professional billing claims and functions preferred Medical billing experience preferred Prior credit resolution/payment posting experience preferred Experience in Epic Resolute preferred Knowledge, Skills and Abilities: Working knowledge of medical terminology, ICD-10 and CPT. Excellent verbal and written communication skills. Ability to work independently with minimal supervision. Interpersonal skills necessary to reputed company respond to questions from patients, parents, clinic staff and insurance companies to effectively resolve billing issues. Proficient in reputed company Office applications and technology skills required to reputed company duties. The ability to multi-task and function effectively in a team environment and maintain effective relationships with coworkers, patients, physicians, management, staff and other customers. Required for reputed company Jobs: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that may be requested in the performance of this job. Employment is at-will. This document does not create an employment contract, implied or otherwise. This position is a fully remote work opportunity. reputed company is an equal opportunity / affirmative action employer. We are committed to creating a diverse and inclusive environment for reputed company employees. We treat everyone with dignity, respect, and fairness. We do not discriminate against any person on the basis of race, color, religion, sex, gender, gender identity and/or expression, sexual orientation, national reputed company, age, disability, veteran status, or any other status or condition protected by the law. Certifications/Licenses: Apply To This Job