Appeal Resolution Specialist jobs in Chicago, IL

About Us

Jorie Healthcare Partners, occupies a uniquely interconnected position at the center of the healthcare industry. An inseparable part of today's healthcare billing ecosystem, with leading edge technology that is driving transformation with our highly acclaimed AI infused Robotic Process Automation for end-to-end Revenue Cycle Management, providing practice and financial management services to the healthcare industry. Applied Intelligence, Better Insight, Accelerated Efficiencies with Jorie Healthcare Partners.

Our work environment includes:

• Modern office setting
• Growth opportunities
• Safe work environment
• Cultural diversity
• Collaborative company culture

Job Description

The Credit Resolution Specialist supports the Revenue Cycle by accurately analyzing posted transactions to determine why there is a credit balance and is responsible for accurate completion and resolution of potential credit balances for health plan payers and patients/guarantors. This position requires detailed analysis and critical thinking to determine what is necessary to correct an account. After review, if 1) a refund is appropriate to either the patient or insurance company, 2) a payment transfer is necessary, or 3) a reversal or correction of a contractual allowance or an administrative adjustment is warranted, then the representative is responsible to correct the postings and/or refund the overpayment to the correct payer(s). In addition, the Credit Resolution Specialist ensures proper account documentation within the facility’s systems and pursues follow-up efforts on credit balances under the supervision of the department leaders. The Credit Resolution Specialist will report to the Credit Resolution Manager.

Responsibilities:

• Generates refund requests and routes resolution to accounts payable for patients and third-party payers
• Refunds overpayments and/or transfers payments to the appropriate account/accounts.
• Enters refunds into the patient accounting system
• Researches and resolves unapplied activity accounts
• Documents any request or concern received via mail, e-mail, telephone, written correspondence, or in person on the patient's account
• Responsible for responding to insurance/patient requests for refunds in a timely manner (within 24 hours of receipt of message for phone calls)
• Identifies the originating cause of the need for a refund, and compiles a report of recurring issues to management
• Maintains confidentiality of all protected health information (PHI)
• Coordinates as required with other departments to resolve claim issues and discrepancies
• Documents activity on patient account, ensures compliance with all applicable regulations
• Other duties as assigned by management

Qualifications:

• High School Diploma or GED required; college degree preferred. Bachelor’s Degree in Accounting, Business Administration or related field preferred.
• Two years of appropriate work experience that would indicate a high level of communication skills and knowledge of the modern revenue cycle
• Experience with analyzing explanation of benefits (EOBs) from various insurance companies/payers
• One year of experience in accounting or bookkeeping; handling cash and/or cash reconciliation in a healthcare facility or hospital, retail business, or bank preferred
• Proficiency with Microsoft office suite (Excel, Word, PowerPoint, Outlook, Visio, SharePoint)

Job Type: Full-time

Salary: $21.00 - $22.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Ability to commute/relocate:

• Oak Brook, IL: Reliably commute or planning to relocate before starting work (Required)

Work Location: In person