Team Lead, Credit Balance Resolution

About the role

This position serves as a technical expert lead for the Credit Balance Resolution team. Responsibilities include training new staff, providing ongoing training to existing staff, and performing all duties of a Credit Balance Resolution Specialist. The role requires a significant degree of independent judgment and decision-making, ensuring the timely completion of the Medicare quarterly credit balance report and other governmental credit balance audits. It involves leadership and direction of daily credit balance workflow functions, creating and updating policies and procedures, and resolving credit balances, undistributed payments, and refund requests through extensive communication with internal and external customers.

Responsibilities

• Provide general assistance to the Credit Balance team.
• Train new staff and provide ongoing training for existing staff.
• Monitor activities performed by Credit Balance staff to ensure timely and appropriate reconciliation of accounts (credit balance, undistributed payments, and requests for refunds).
• Complete quality improvement and productivity activities.
• Answer questions regarding team functions and assist with team direction.
• Review credit balances, undistributed payments, and requests for refunds to determine the appropriate course of action.
• Conduct timely and accurate reviews of credit balances and refund requests to ensure compliance with contractual obligations, payer, and regulatory requirements.
• Initiate refunds to patients, guarantors, insurance companies, and other third parties following established procedures.
• Review refund requests from payers with contracted recoupment language to reduce future recoupment reconciliations.
• Review, validate, and correct adjustments on accounts based on insurance reimbursement, benefit coverage guidelines, 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 of 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.
• Review and resolve accounts assigned via work lists daily as directed by management.
• Support the Manager as needed.

Requirements

• High school diploma or equivalent or higher.
• Associate Degree in Business, Finance, Health Information Management, or three years of experience in a healthcare revenue cycle or clinic operations leadership role with progressive responsibilities.
• 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

• Effective interpersonal skills, including the ability to promote teamwork.
• Excellent time management skills and the ability to handle multiple, simultaneous tasks effectively.
• Basic math skills and knowledge of general accounting principles.
• Strong verbal and written communication skills.
• 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 and efficiency.
• Strong problem-solving skills.
• Strong quantitative, analytical, and organizational skills.
• Advanced understanding of an Explanation of Benefits (EOB).
• Knowledge of CPT, ICD-10, and HCPCS coding standards.
• Understanding of CMS Memos and Transmittals.
• Proficiency in computer technology.
• Ability to manage multiple tasks with ease and efficiency.
• Self-starter with a willingness to try new ideas.
• Ability to work independently and be result-oriented.
• Understanding of insurance terms and payment methodologies.

Pay

$18.38 - $26.79/hr

Schedule

Monday - Friday day shift (onsite role based out of Greenville, NC)

Benefits

Great Benefits