Credit Specialist

Job Description

The vision of Clinical Health Network for Transformation (CHN) is to support the mission and promise of Planned Parenthood to bring high-quality, affordable care to every member of our communities. CHN is a collaboration between Planned Parenthood affiliates across the United States.

CHN is looking for individuals who are committed to supporting our shared goal of strengthening and enhancing our awareness and commitment to advancing the cause of health equity in our organization.

Reporting directly to the Payment Posting Manager, the Credit Specialist is responsible for understanding payor requirements and contracts to determine appropriate next steps to resolve accounts with credit balances. Analyzes and resolves issues pertaining to credit balances, including review of reminders from billers, payments, adjustments, and written requests for refunds before preparing appropriate documents for management review and approval. Makes follow-up phone calls to insurance companies or policyholders whenever necessary regarding credit balances or overpayments.

Essential Functions

• Research credit balances on patient accounts for both patient and payer
• Investigate each credit balance to determine if an over payment has been made
• Determine the correct course of action to resolve the refund request or credit balance which could include but not limited to:
• Accurate completion of refund request for submission to refund department.
• Requesting payment corrections or adjustment corrections as needed.
• Requesting transfer of patient payments to other patient accounts that have patient balances that may reside in patient accounting system.
• Notify payor representative to initiate takeback (recoupment) and provide support documentation as required to the payor representative.
• Perform payment corrections or adjustment corrections, as needed
• Process 'transfer of patient' payments to other patient accounts with outstanding balances within the patient accounting system
• Ensures complete, accurate, and timely account notation and documentation in EPIC, including adjudication and credit balance refund processing.
• Prepare appropriate refund task in EPIC for payor/patient refund request received
• Review and follow up on refund/offset requests to ensure completion in a timely manner
• Contribute to workflow/ improvement processes for credit balances.
• Manage daily work queues of credit balances to ensure accounts are resolved timely
• Perform regular reconciliations of patient accounts to ensure accuracy and completeness
• Investigate and resolve any discrepancies or disputes related to patient accounts in a timely manner
• Ensure compliance with credit balance review processes
• Perform various clerical activities to support daily operations
• Ensures compliance with all CHN and affiliate policies, as well as all state and federal regulations
• Demonstrates a commitment to CHN and Planned Parenthood’s mission related to health equity, especially centering racial equity, and deep sense of accountability to community
• Demonstrates a commitment to learning about and enhancing practices related to racial equity and the impact of structural racism on healthcare systems
• Provides positive and development feedback and accountability related to practices including, but not limited to, equity

The above duties and responsibilities are not an exhaustive list of required responsibilities, duties, and skills. Other duties may be added, and this job description can be amended at any time.

Qualifications and Experience (Required)

• Minimum of 3 years of relevant account receivable experience
• A good understanding of the coordination of benefits
• Experience in account inquiries and analysis to investigate and evaluate the payment methodology and accuracy, required
• Clear understanding of contract terms, payer policy, and strong understanding of explanation of benefits
• Strong analytical and problem-solving abilities
• Proficiency with Microsoft software (Excel, etc.)
• Demonstrated ability to maintain a customer-centric service approach in a fast-paced environment
• Excellent written and verbal communication skills and ability to collaborate and interact with all levels within and outside of CHN if necessary
• Strong attention to detail and follow-up; and ability to multi-task in fast-paced environment
• Demonstrated dedication to Planned Parenthood’s mission, vision, and values
• Strong interpersonal skills and the ability to build relationships with stakeholders
• Excellent time management, and problem-solving skills

Qualifications and Experience (Preferred)

• Strong General Technology Skills: proficient utilization of Excel, Word, and Windows environment, Epic, eCW, NextGen or other practice management systems experience a plus
• Medical Billing and Coding certification, a plus

Key Requirements

• Commitment to advancing race (+) equity in one’s work: interested in expanding knowledge about the role that inequity plays in our society
• Awareness of multiple group identities and their dynamics, bringing a high level of self-awareness about personal identity, empathy, and humility to interpersonal interactions
• Demonstrated ability to communicate clearly and directly as well as hear and act on feedback related to identity and equity with the aim to learn
• Strong sense of accountability to equitable practices
• Commitment to CHN Mission, Values, & Norms as well as Planned Parenthood’s ‘In This Together’ service ethos, workplace values, and service standards

We comply with all applicable laws prohibiting discrimination based on race, color, religion, gender and gender expression/identity, age, ethnicity, national origin, ancestry, physical or mental disability, uniformed service member/veteran status, marital status, medical condition, pregnancy, sexual orientation, citizenship status, genetic information, as well as any other category protected by federal, state, or local. We are committed to building an inclusive workplace that values racial & social justice. We strongly encourage all persons to apply, including members from all racial and ethnic groups and members of the LGBTQIA+ community.