Credit Balance Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Review patient accounts with credit balances to validate the accuracy of overpayments by assessing EOBs, remittance advices, payment history, COB sequencing, and anticipated reimbursements prior to issuing any refunds.

• Determine the underlying causes of credit balances such as posting mistakes, duplicate payments, COB discrepancies, contract inconsistencies, unapplied cash, and erroneous adjustments.

• Confirm refund requests and takeback notifications from third-party payers against contracts, payment history, and claim adjudication to avert inappropriate refunds.

• Investigate unapplied payments by reconciling remittance advices, deposits, and account histories to assign funds to the appropriate accounts.

• Examine intricate multi-payer situations involving Medicare/Medicaid crossovers, third-party liability, workers' compensation, motor vehicle accidents, and secondary/tertiary billing.

• Make independent and justifiable decisions on complex cases necessitating the interpretation of payer contracts, billing regulations, and revenue cycle policies.

• Collaborate with payment posting, AR follow-up, contract management, and patient financial services to address account issues at their source.

• Accurately and promptly process patient and payer refunds in compliance with state escheatment laws and federal overpayment regulations.

• Professionally communicate with insurance companies, patients, and internal departments regarding inquiries related to credit balances.

• Record all account activities and resolution processes with clear, concise, and actionable notes.

• Uphold productivity and quality standards in a high-volume, deadline-oriented environment.

• Ensure full compliance with HIPAA, billing standards, CMS regulations, and fraud/abuse regulations.

• Responsibilities may shift across client portfolios and credit balance categories based on volume and priority within the role.

⛳️ Requirements

• High School Diploma or GED required.

• 4-7 years of experience in hospital and/or physician accounts receivable with direct involvement in credit balance resolution.

• Preferred experience in resolving credit balances for both facility (UB-04) and professional (CMS-1500) claims.

• Background in payment posting, denials management, or revenue integrity is preferred.

• CRCR (Certified Revenue Cycle Representative) or a comparable certification is preferred.

• Demonstrated success in resolving complex credit balance issues and payment discrepancies.

• In-depth understanding of revenue cycle workflows, coordination of benefits, and payer hierarchy (primary/secondary/tertiary).

• Familiarity with managed care contracts, reimbursement methods, and claim adjudication processes.

• Strong analytical skills for interpreting EOBs, remittances, contracts, and payment documentation.

• Knowledge of state escheatment/unclaimed property laws and the CMS 60-day overpayment rule.

• Proficient in navigating hospital or physician EHR, PMS, and billing systems.

• Familiarity with ERA/EFT processing, clearinghouses, and payer portals is preferred.

• Advanced proficiency in Excel (including pivot tables, VLOOKUP, formulas, and data analysis).

• Ability to establish and maintain effective working relationships with team members, supervisors, managers, clients, and providers.

• Capable of prioritizing workload and managing multiple responsibilities in a well-organized and efficient manner.

• Knowledge of HIPAA, billing compliance, CMS regulations, and fraud/abuse regulations.

🏝️ Benefits

• Access to a 401(k) Retirement Savings Plan.

• Comprehensive Medical, Dental, and Vision Coverage.

• Paid Time Off.

• Paid Holidays.

• Additional benefits, including Pet Care Coverage, Employee Assistance Program (EAP), and discounted services.