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Job/Position Description
Position Title: Credit Specialist
Department Name: Cash Management - Thornton
UPH Affiliate: UPH-System Services
Department Number: 9010-9010-Varies
Effective Date: March 2017
Review Date(s): 3/2017
Prepared By: Supervisor Billing-Cash Posting
Approved By: VP Reimbursement
Position Reports To: Supervisor Billing – Cash Posting
Description of Position:
Provide a “snapshot” or the principal purpose or focus of the position, consisting of no more than three to five sentences. This summary should provide enough information to differentiate the major function and activities of the position from those of other positions.
Research patient and insurance credit balances from system work lists and request appropriate refunds. Efficiently process refund requests received from Insurance Companies and Responsible Parties. Authorize and process credit balances requested by staff within the organization subject to authorization maximum. Act as resource for billing office staff concerning credit balances.
Essential Functions/Responsibilities:
Essential functions are the duties and responsibilities that are essential to the position (not a task list). o not include if less than 5% of work time is spent on this duty. Be specific without giving explicit instructions on how to perform the task. Do not include duties that are to be performed in the future. Duties should be action oriented and avoid vague or general statements.
% of Time
(annually)
Refund Processing
Ensure patient satisfaction through timely and effective processing of refund requests.
Respond to communication from third-party payors with requests for refunds.
Daily monitoring and resolution of credit balances via reports and/or correspondence, workques, patient, clinic phone calls or emails.
Review, audit, and process accounts in credit balance WQ’s identifying accounts for which a refund is due.
Effectively authorize and process refund requests submitted by staff outside and within the department.
Submit inquiries to payers to request a recoup be performed.
Trace errors, record adjustments to proper accounts, and determine the appropriate destination for refunds due.
Resolve account discrepancies by auditing account detail.
60%
Excellence in Patient Billing Using knowledge of payor guidelines for co-pays, deductibles, co-insurances, and out of pocket expenses to insure all patient or Third party responsibility is collected before any refunds are generated
Balance all refunds processed to ensure amounts equal to Accounts Payable total refunds amount for the week.
Follow all Federal, State and industry requirements of overpayment timelines
Completes special projects and monthly reports as assigned.
Demonstrate a professional image in dealing with the public, patients, families, and vendors.
Share responsibility through timely communication of identified problems to assure proper follow up is completed to expedite resolution of patient accounts issues.
20%
Systems Competency
Demonstrate competency with all applicable software programs.
Performs other duties as assigned.
10 %
Basic UPH Performance Criteria
Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.
Demonstrates ability to meet business needs of department with regular, reliable attendance.
Employee maintains current licenses and/or certifications required for the position.
Practices and reflects knowledge of HIPAA, TJC, DNV, OSHA and other federal/state regulatory agencies guiding healthcare.
Completes all annual education and competency requirements within the calendar year.
Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of hospital administrative staff. Takes appropriate action on concerns reported by department staff related to compliance.
10%
Disclaimer: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that required of the employee. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.
Demonstration of UPH Values and Standards of Behaviors
Consistently demonstrates UnityPoint Health’s values in the performance of job duties and responsibilities
Foster Unity:
Leverage the skills and abilities of each person to enable great teams.
Collaborate across departments, facilities, business units and regions.
Seek to understand and are open to diverse thoughts and perspectives.
Own The Moment:
Connect with each person treating them with courtesy, compassion, empathy and respect
Enthusiastically engage in our work.
Accountable for our individual actions and our team performance.
Responsible for solving problems regardless of the origin.
Champion Excellence:
Commit to the best outcomes and highest quality.
Have a relentless focus on exceeding expectations.
Believe in sharing our results, learning from our mistakes and celebrating our successes.
Seize Opportunities:
Embrace and promote innovation and transformation.
Create partnerships that improve care delivery in our communities.
Have the courage to challenge the status quo.
QUALIFICATIONS:
Minimum Requirements
Identify items that are minimally required to perform the essential functions of this position.
Preferred or Specialized
Not required to perform the essential functions of the position.
Education:
High school diploma or GED equivalent.
Experience:
General knowledge of bookkeeping, basic accounting, and familiarity with insurance industry practices.
General knowledge of CPT and ICD9 codes.
Strong analytical, organizational, and communication skills required.
Minimum of two years related work experience in a health care environment.
Demonstrated knowledge of managed care principles, insurance industry practices, and medical terminology required.
Excellent verbal and written communication skills necessary.
Ability to operate data entry equipment and related computer systems.
Typing skills of 40wpm.
Ability to concentrate and pay close attention to detail.
License(s)/Certification(s):
Valid driver’s license when driving any vehicle for work-related reasons.
Knowledge/Skills/Abilities:
Writes, reads, comprehends and speaks fluent English
Basic computer knowledge using word processing, spreadsheet, email and web browser.
Other:
Use of usual and customary equipment used to perform essential functions of the position.
SCOPE: Position has supervisory responsibilities? Yes ☐ or No ☒ If yes, complete below.
Number of Employees Supervised (Complete if position has supervisory responsibilities of individuals)
Direct
Indirect
Total
Exempt
Non-Exempt
Total
Budget Control (Complete if position has budget responsibilities)
Annual Operating Budget (including payroll)
Annual Revenue/Sales
Other Scope Measurements
Pertinent to the position, such as number of beds, number of units/departments, number of employees leading, cases per month, etc.
Item
Number
Mental/Cognitive Demands:
(List any special mental and cognitive abilities required by the position in your specific environment)
Demonstrated knowledge of managed care principles, insurance industry practices, and medical terminology required.
Excellent verbal and written communication skills necessary.
Must be able to concentrate in a busy office, shared with other staff members.
Ability to operate data entry equipment and related computer systems.
Typing skills of 40wpm.
Ability to concentrate and pay close attention to detail.
WORKING CONDITIONS:
Physical Requirements
(Check all that apply if essential to perform job – with or without accommodations)
☒ Talk/Hear (communicate, detect, converse with, discern, convey, express oneself, exchange information)
☒ See (defect, determine, perceive, identify, recognize, judge, observe, inspect, estimate, assess)
☒ Stand or Sit (stationary position)
☒ Walk (move, traverse)
☒ Use hands/fingers to handle or feel (operate, activate, use, prepare, inspect, place, detect, position)
☐ Climb (stairs/ladders) or Balance (ascent/descent, work stop, traverse)
☒ Bend/Stoop/Kneel
☒ Squat/Crouch/Crawl
☒ Reaching/Twisting
☒ Taste/Smell (detect, distinguish, determine)
☒ Pushing/Pulling
Lifting Requirements
(Check appropriate category to perform job – with or without accommodations)
☒ Level 1; Sedentary Work: Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.
☐ Level 2; Light Work: Exerting up to 20 pounds of force occasionally or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. Requires walking or standing to a significant degree, pushing or pulling arm or leg controls or maintaining a production rate pace. Light work requires physical exertion of forces greater than that of sedentary work.
☐ Level 3; Medium Work: Exerting up to 50 pounds of force occasionally, and/or up to 20 pounds of force frequently, and/or up to 10 pounds of force constantly to move objects.
☐ Level 4; Heavy Work: Exerting up to 100 pounds of force occasionally, and/or up to 50 pounds of force frequently, and/or up to 20 pounds of force constantly to move objects.
☐ Level 5; Very Heavy Work: Exerting in excess of 100 pounds of forces occasionally, and/or in excess of 50 pounds of force constantly to move objects.
Hazards and Atmospheric Conditions
(check all that apply)
☒ Normal Office Surroundings
☐ Vibration
☐ Exposure to Fumes
☐ Mechanical Hazards
☐ Exposure to Dust
☐ Chemical Hazards
☐ Exposure to Extreme Temperatures
☐ Electrical Hazards
☐ Wet and/or Humid
☐ Radiant Energy Hazards
☐ Noise
☐ Explosives Hazards
☐ Mists or Gases
☐ Burn Hazards
Other/Comments:
Precautions must be followed when working in any health care environment.
OSHA Categories
(Complete this OSHA section for clinical/patient related jobs)
☐ Category I: Duties performed routinely require exposure to blood, body fluid and tissue.
☐ Category II: Normal routine involves no exposure to blood, body fluid or tissue, but exposure or potential for exposure may occur.
☒ Category III: Normal routine involves no exposure to blood, body fluid, or tissue and as part of their employment, incumbents are not called upon to perform or assist in emergency care or first aid.
To Be Completed by Compensation Analyst
FLSA Designation: Non-Exempt
Lawson Job Level: Staff
Lawson Job Category: Billing/Registration/Scheduling
Lawson Job Sub-Category:
Lawson Job Code: 696
Lawson Job Title: Patient Acct/Insurance Rep
Short Term Incentive Eligibility: Staff
Union Affiliation: NA
Founded in 2003, Omega Healthcare Management Services® (Omega Healthcare) empowers healthcare to thrive via intelligent solutions that optimize revenue cycle operations, administrative workflows, care coordination, and clinical research on a global scale. The company works with providers, payers, life science companies, medical device manufacturers, health technology firms, researchers, and industry partners to amplify teams with robust technology, specialty expertise, and operational support. Omega Healthcare serves more than 350 healthcare organizations with 35,000 skilled workers in the United States, India, Colombia, and the Philippines. For more information, visit www.omegahms.com
We offer a comprehensive benefits package that may include health, dental, and vision coverage, voluntary insurance options, a 401(k) plan with employer match, professional development opportunities, paid time off, and holiday pay. Eligible employees may also have the opportunity to participate in bonus programs, commissions, or other variable incentive plans. Benefits and incentive eligibility may vary based on position, location, and tenure.
AAP/EEO Statement
Omega Healthcare is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, gender, age, sexual orientation, gender identity or expression, marital status, mental or physical disability, protected veteran status, and genetic information, or any other basis protected by applicable law. Omega Healthcare also prohibits harassment of applicants or employees based on any of these protected categories.
Omega Healthcare makes reasonable accommodations when needed for applicants and candidates with disabilities or religious observances. If reasonable accommodation is needed to participate in the job application, interview, or any other part of the hiring process, please contact Human Resources at employeerelationsus@omegahms.com.
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