Credit Specialist - Hospital Billing

Schedule: Full time 

Main Function: 

• The primary function of the Hospital Credit Specialist is to meticulously manage and resolve credit balances across our five health systems and six hospitals. This involves identifying, researching, and processing overpayments from patients and various payers, ensuring all refunds are accurate, timely, and compliant with regulatory standards. This role is crucial for maintaining the financial health and integrity of our organization by effectively managing outstanding credit balances.

Job Specific Competencies: 

• Credit Balance Resolution Expertise: Proficiently identify, investigate, and resolve complex credit balances from diverse sources (patient, commercial, Medicare, Medicaid) across multiple hospital entities.
• Account Analysis & Reconciliation: Ability to conduct in-depth analysis of patient accounts, reviewing payment postings, contractual adjustments, charge entries, and claim processing to pinpoint the root cause of credit balances.
• Regulatory & Payer Compliance: Strong understanding and adherence to federal, state, and local regulations, including Medicare and Medicaid guidelines, as well as commercial payer contracts related to credit balance management and refunds.
• Interdepartmental Communication: Effectively communicate and collaborate with patients, insurance companies, and internal departments (e.g., Patient Access, Patient Accounts) to gather information and facilitate resolutions.
• System Proficiency: Skilled in navigating and utilizing various billing systems, electronic health records (EHRs), and financial software platforms specific to each health system.
• Documentation & Accuracy: Meticulous in maintaining detailed and accurate documentation of all research, communication, and resolution steps within the patient accounting system.
• Problem-Solving & Analytical Thinking: Exceptional ability to analyze complex financial data, identify discrepancies, and develop effective solutions for credit balance issues.
• Process Improvement Orientation: Proactively identify trends in credit balances and suggest potential enhancements to current processes to prevent future overpayments and improve overall revenue cycle efficiency.

Qualifications: 

• Multi-System Experience: Proven ability to manage billing and credit processes for multiple health systems or hospitals simultaneously is highly preferred.
• Knowledge: In-depth understanding of hospital revenue cycle operations, medical billing terminology, CPT/ICD-10 coding, and payer reimbursement methodologies (Medicare, Medicaid, commercial insurance).
• Skills:
  • Exceptional analytical and problem-solving abilities.
  • Strong attention to detail and accuracy.
  • Excellent verbal and written communication skills.
  • Proficiency in using patient accounting systems (e.g., Epic, Cerner, Meditech) and Microsoft Office Suite (Excel, Word).
  • Ability to work independently and as part of a team in a fast-paced, high-volume environment.
  • Strong organizational and time management skills.

Education and Experience: 

• Required: High school diploma or equivalent.
• Preferred: Associate's or Bachelor's degree in Business Administration, Finance, Healthcare Administration, or a related field.
• Required: Minimum of 3 years of dedicated experience in hospital billing, with a strong emphasis on credit balance resolution and refund processing.
• Highly Preferred: Demonstrated experience managing billing and credit processes for multiple health systems or hospitals simultaneously.

Pay Range: $20.00 - $25.00

Starting Pay: Based on experience 

Thompson Health is an EOE encouraging individuals with disabilities and veterans to apply