Job Description:
• Work assigned credit balance inventory queues daily for hospital and physician accounts, prioritizing accounts based on ageing, dollar amount, payer requirements, and regulatory timelines.
• Research the root cause of credit balances, including duplicate payments, overpayments, coordination of benefits errors, retroactive adjustments, contractual discrepancies, and posting inaccuracies.
• Determine the appropriate resolution method for each credit balance, including: Refunds to payers or patients, Reallocation of payments to open balances, Contractual or administrative adjustments, when applicable.
• Prepare and submit refund requests with complete and accurate supporting documentation.
• Review remittance advice (ERAs/EOBs) and account transaction history to validate overpayment sources and resolution accuracy.
• Apply credits to the oldest dates of service first, unless otherwise required by payer or regulatory guidelines.
• Maintain clear, detailed account notes documenting research performed, actions taken, and final resolution.
• Monitor payer and regulatory timelines to ensure timely resolution and avoid compliance risk.
• Escalate complex, high-dollar, or non-standard credit balance scenarios in accordance with established workflows.
• Partners with payment posting, insurance follow-up, billing, coding, and refund teams to resolve credit balances requiring cross-functional action.
• Identify and report recurring credit balance drivers, payer trends, or system issues to leadership.
• Support audit requests and quality reviews by providing account documentation and resolution details.
• Participate in process improvement initiatives to reduce future credit balance volume.
• Meet or exceed established productivity standards for credit balance accounts resolved.
• Maintain high accuracy and compliance with payer contracts, refund policies, and regulatory requirements.
• Ensure timely resolution of credit balances in accordance with organizational and payer timelines.
• Adhere to documentation, audit, and compliance standards.
Requirements:
• High school diploma or equivalent required.
• 3+ years of healthcare revenue cycle experience focused on credit balance resolution.
• Strong attention to detail and ability to work effectively in a fast-paced environment.
• Strong understanding of billing and collections processes.
• Strong understanding of ERAs/EOBs, payer contracts, and overpayment resolution workflows.
• Proficiency with patient accounting and practice management systems.
• Ability to manage high-volume credit balance inventory independently.
• Disciplined work ethic with ability to work remotely with little direct supervision and meet production targets.
• Analytical and detail-oriented.
• Strong prioritization and time management.
• Clear written documentation.
• Compliance-focused decision-making.
• Collaborative problem-solving.
Benefits:
• Insurance/401k match
• PTO/Paid holidays
• Referral bonuses
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