Credit Balance Resolution Specialist

About the role

The Credit Balance Resolution Specialist resolves credit balances, undistributed payments, and refund requests from insurance companies, patients/guarantors, or other payers through phone, fax, and written correspondence. This role works with internal and external customers—including third-party payers, patients, estate representatives, attorneys, employers, and ECU Health employees—to facilitate prompt resolution of credit balances or refund requests. Responsibilities include researching insurance benefits, understanding coordination of benefits, redistributing or transferring payments, updating account adjustments, generating refund requests, and addressing overpayment notifications or denying refunds according to policy and contract guidelines.

Responsibilities

• Conduct timely and accurate review of credit balances, undistributed payments, and refund requests to determine appropriate action.
• Initiate refunds to patients, guarantors, insurance companies, and other third parties following established procedures, contractual obligations, and regulatory requirements.
• Review refund requests from payers with contracted recoupment language to reduce future recoupment reconciliations.
• Review, validate, and correct account adjustments based on insurance reimbursement, benefit coverage guidelines, contracted payers, and services provided.
• Redistribute and/or transfer payments between professional billing (PB) and hospital billing (HB) accounts.
• Validate and update patient demographic and insurance information to ensure accuracy for future claims.
• Reconcile misdirected and clearing accounts by researching and posting payments to the correct accounts.
• Ensure correct reimbursement rates are reflected in refund requests.
• Maintain accurate system documentation with notes and standard note codes.
• Adhere to the Compliance Plan and all applicable local, state, and federal regulations and accrediting bodies.
• Review and resolve accounts assigned via work lists daily as directed by management.
• Support the Team Lead and Manager as needed.

Requirements

• High school diploma, equivalent, or higher.
• Minimum of five years of experience in insurance, finance, medical office, or customer service-related field.
• Knowledge of managed care contract billing guidelines.
• Revenue Cycle (healthcare business, financial, or insurance) experience.
• Epic experience.
• Knowledge of medical and insurance terminology, CPT, ICD, and HCPCS coding structures, and billing forms (UB, 1500).

Skills

• Strong problem-solving skills.
• Strong quantitative, analytical, and organizational skills.
• Advanced understanding of Explanation of Benefits (EOB).
• Knowledge of CPT, ICD-10, and HCPCS coding standards.
• Understanding of CMS Memos and Transmittals.
• Proficiency in computer technology.
• Excellent verbal and written communication skills.
• Ability to manage multiple tasks efficiently and effectively.
• Self-starter with a willingness to try new ideas.
• Ability to work independently and be results-oriented.
• Understanding of insurance terms and payment methodologies.

Performance Expectations

• Excellent time management skills with the ability to handle multiple, simultaneous tasks professionally and courteously.
• Strong interpersonal skills and ability to work well with others.
• Detail-oriented and organized.
• High integrity, including maintenance of confidential information.
• Ability to exercise good judgment and positively influence and lead others, including handling confrontations with poise.
• Proficiency in the use of internal automation and software applications.
• Illustrates autonomous, best revenue cycle practices.

Pay

$16.31 - $23.78 per hour.

Schedule

Monday - Friday day shift: 8:00 a.m. - 4:30 p.m. (onsite role based in Greenville, NC).

Benefits

Great benefits package available.