Senior Patient Account Specialist – Credit Balance

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

📋 Description

• Support the Patient Account Supervisor in overseeing patient and third-party payer payments.

• Address overpayments from patients and third-party payers, manage credit balances, and handle refund requests.

• Investigate insurance benefits and facilitate coordination of benefits among payers.

• Allocate, reapply, or transfer payments to the correct date of service or account.

• Prepare refund requests, notify about overpayments, or issue refund denials in accordance with established guidelines.

• Assign workloads and adjust staff priorities as needed.

• Supervise the Credit Balance team's activities to ensure timely and accurate reconciliation.

• Engage with payers regarding overpayments, request recoupments, and void claims when appropriate.

• Assess, confirm, and amend account adjustments based on reimbursement details, coverage, contracted payers, and the services rendered.

• Check and update patient demographic information and insurance details.

• Initiate refunds for patients, guarantors, insurance companies, and other relevant third parties.

• Verify benefits through online platforms and phone resources.

• Evaluate refund and adjustment requests for correctness and submit them as needed.

• Aid in the development of workflows and provide staff training.

• Participate in special projects and ad hoc claims reviews as assigned by leadership.

• Collaborate with CBO departments to address outstanding claim activities.

• Achieve accuracy and productivity benchmarks related to accounts receivable days and cash collections.

• Attend mandatory staff and company meetings.

• Carry out additional duties as assigned.

⛳️ Requirements

• High School Diploma or GED is required.

• A minimum of 3 years of relevant experience in either an inpatient or outpatient provider setting is required.

• In-depth knowledge of claims processing, appeals, medical terminology, accounts receivable, claim forms, claims billing, insurance verification, adjustments and refunds, claims status, and reimbursement is required.

• At least 2 years of prior Team Leader/Supervisory experience or an equivalent role is required.

• Extensive knowledge of all payer insurance groups, including Medicare, Medicaid, and government managed care experience is required.

• Previous experience in coaching and/or training, along with the ability to develop training manuals and materials, is preferred.

• Experience with medical records or patient accounting systems is required.

• Knowledge and comprehension of state and Federal payment laws to ensure prompt and accurate reimbursement is required.

• Advanced understanding of healthcare explanations of benefits (EOBs) is required.

• Intermediate proficiency in Microsoft Office products (Outlook, Excel, Word), including skills in Excel such as vlookup/xlookup, pivot tables, and basic formulas, is required.

• Fluency in English, both written and oral communication, is essential.

🏝️ Benefits

• A workplace that emphasizes teamwork.

• Commitment to diversity, equity, and inclusion.

• Equal access to information, development, and opportunities.