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 regulatory 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 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, contracted payers, and services provided.
• Redistribute and/or transfer payments between PB/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 or 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 experience (healthcare business, financial, or insurance).
• 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 independently.
• Self-starter with a willingness to try new ideas.
• Result-oriented with a focus on revenue cycle best practices.
• Understanding of insurance terms and payment methodologies.
• Detail-oriented, organized, and able to maintain confidential information.
• Ability to exercise good judgment and handle confrontations with poise.

Performance Expectations

• Demonstrate excellent time management and ability to handle multiple tasks simultaneously while maintaining professionalism.
• Work collaboratively with others.
• Illustrate proficiency in internal automation and software applications.
• Uphold high integrity and ethical standards.

Pay

$16.31 - $23.78 per hour.

Schedule

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

Benefits

Comprehensive benefits package available.

About ECU Health

ECU Health is a mission-driven, 1,708-bed academic healthcare system serving over 1.4 million people across 29 eastern North Carolina counties. The not-for-profit system includes 13,000 team members, nine hospitals, and a physician group with over 1,100 providers practicing in more than 180 clinics. ECU Health Medical Center (a Level I Trauma Center) and ECU Health Maynard Children’s Hospital serve as primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined mission to improve health and well-being in eastern North Carolina through patient care, education, and research.