Credit Balance Review Specialist

Responsibilities

• Research credit balances on patient accounts
• Determine the correct course of action to resolve refund requests or credit balances, which could include:
  • Accurate completion of refund request for submission to refund department
  • Requesting payment corrections or adjustment corrections as needed
  • Requesting transfer of patient payments to other patient accounts that have balances in the patient accounting system
• Work closely with third-party payors throughout the refund and credit issue resolution process
• Maintain knowledge of insurance payments and rejection/denial processes
• Update credit balance/refund reports as necessary
• Notify payor representatives to initiate takeback (recoupment) and provide support documentation as required
• Submit validated refund request documents for lead review and approval
• Ensure complete, accurate, and timely account notation and documentation in the patient accounting system, including adjudication and denial processing
• Work closely with the Team Leads of the CBO

Qualifications

• High School diploma or GED equivalent
• 2+ years prior related Healthcare Facility Revenue Cycle experience, preferably with credit balance resolution
• Experience in account inquiries and analysis to investigate and evaluate the payment methodology and accuracy
• Clear understanding of contract terms, payer policy, and strong understanding of explanation of benefits
• Excellent written, verbal communication and interpersonal skills
• Ability to work independently, prioritize work, and be results-oriented
• Strong math aptitude
• Demonstrated ability to use office productivity tools such as Microsoft Outlook, Word, and general computer skills necessary to work effectively in an office environment
• Demonstrated ability to use Microsoft Excel to download reports and manipulate data using formulas and pivot tables