Credit Processing Specialist, FT, Days, - Remote Prisma Health - 3.5 Columbia, SC Job Details Full-time 23 hours ago Qualifications Appeals Accounts receivable management Account maintenance Account analysis Account troubleshooting Regulatory compliance in claims processing HIPAA Medical billing compliance checks Mid-level Financial issue resolution High school diploma or GED Quality assurance Decision making Financial record maintenance Medical denial root cause analysis (RCA) Health information regulatory compliance Medical insurance appeals management Data interpretation Medical billing account reconciliation Payment reconciliation Root cause analysis Customer payment analysis report Accounting error correction Insurance claims appeal handling Healthcare coding investigations 2 years Healthcare accounting Full Job Description Inspire health. Serve with compassion. Be the difference. Job Summary Performs tasks of moderate to difficult complexity relating to physician and hospital accounts. Responsible for data analysis and interpretation throughout all functions of revenue cycle, analysis of aged accounts including remittances to determine reasons for denials, non-payment and overpayment, post/balance/correct electronic remittances, billing and follow-up of government payers and specialized accounts, analysis/correction of correct coding guidelines, preparation of accounts for appeal, review/analysis of insurance credit balances and/or patient credits to include analysis/movement of unapplied, unidentified, undistributed balances. Moderate to difficult levels of evaluation, analysis, decision making required in these roles. Essential Functions All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference. Analyzes insurance and/or patient credit balances to determine root cause, takes action to resolve account. Contacts payer and makes hard inquiries on account status. Escalates problem account. Documents billing activity on the patient accounts according to departmental guidelines; ensures compliance with all applicable billing regulations and reports any suspected compliance issues to departmental leaders. Properly documents accounts clearly with indicators and activities so that tracking and trending can be prepared for further analysis. Ensures all work is compliant with privacy, HIPAA, and regulatory requirements. Participates in general or special assignments and attends all required training. Adheres to policies and procedures as required by Prisma Health and follows all compliant regulatory payer guidance. Performs other duties as assigned. Supervisory/Management Responsibilities This is a non-management job that will report to a supervisor, manager, director or executive. Minimum Requirements Education - High School diploma or equivalent OR post-high school diploma / highest degree earned Experience - Two (2) years billing, bookkeeping, accounting experience In Lieu Of NA Required Certifications, Registrations, Licenses NA Knowledge, Skills and Abilities Knowledgeable of the job functions required for a Denial/Appeals Specialist, Payment Research Specialist and a Quality Assurance Specialist. Work Shift Day (United States of America) Location 1205 Colonial Life Blvd W Facility 7001 Corporate Department 70019935 System Billing Office Share your talent with us!

Our vision is simple:

to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.