Role Description

This role involves performing tasks of moderate to difficult complexity relating to both hospital and physician accounts.

• Handles a large volume of inbound calls and makes outbound calls related to self-pay follow up on accounts.
• Assists patients with requests for information, complaints, and resolving issues.
• Responsible for data analysis and interpretation throughout all functions of revenue cycle.
• Determines 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 and preparation of accounts for appeal.
• Review/analysis of insurance credit balances and analysis/movement of unapplied, unidentified, undistributed balances.
• Moderate to difficult levels of evaluation, analysis, and decision making required.

Qualifications

• High School diploma or equivalent OR post-high school diploma / highest degree earned.
• Two (2) years billing, bookkeeping, and/or accounting experience.

Requirements

• Knowledgeable of job functions required for various roles including A/R Follow-up Representative, Cash Posting Representative, Claims Clearinghouse Representative, Correspondence Representative, Credit Processing Specialist, Denial/Appeals Specialist, Payment Research Specialist, and Quality Assurance Specialist.
• Knowledgeable of the entire Revenue Cycle and Epic.

Benefits

• 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.

Company Description

Prisma Health is the largest not-for-profit health organization in South Carolina, serving more than 1.2 million patients annually.

• Our 32,000 team members are dedicated to supporting the health and well-being of you and your family.
• Our promise is to: Inspire health. Serve with compassion. Be the difference.