AI-Powered Patient Access & Revenue Cycle Solutions
Credit Balance Specialist
Location
United States
Posted
19 hours ago
Salary
0
Seniority
Senior
Job Description
Credit Balance Specialist
Infinx
• Analyze patient accounts with credit balances, validating overpayment accuracy by evaluating EOBs, remittance advices, payment history, COB sequencing, and expected reimbursement before processing any refund • Identify root causes of credit balances including posting errors, duplicate payments, COB failures, contract variances, unapplied cash, and incorrect adjustments • Validate refund requests and takeback notifications from third-party payers against contracts, payment history, and claim adjudication to prevent inappropriate refunds • Research and resolve unapplied payments by reconciling remittance advices, deposits, and account histories to allocate funds to the correct accounts • Investigate complex multi-payer scenarios involving Medicare/Medicaid crossovers, third-party liability, workers' compensation, motor vehicle accident, and secondary/tertiary billing • Make independent, defensible decisions on challenging cases requiring interpretation of payer contracts, billing regulations, and revenue cycle policy • Coordinate with payment posting, AR follow-up, contract management, and patient financial services to resolve account issues at the root • Process patient and payer refunds accurately and timely in accordance with state escheatment laws and federal overpayment rules • Communicate professionally with insurance companies, patients, and internal departments regarding credit balance inquiries • Document all account activity and resolution steps with clear, concise, and actionable notes • Maintain productivity and quality standards in a high-volume, deadline-driven environment • Maintain full compliance with HIPAA, billing compliance, CMS regulations, and fraud/abuse regulations • Assignments may shift across client portfolios and credit balance categories based on volume and priority within the scope of the role
Job Requirements
- High School Diploma or GED
- 4-7 years of hospital and/or physician accounts receivable experience with hands-on credit balance resolution responsibilities
- Experience with both facility (UB-04) and professional (CMS-1500) credit balance resolution preferred
- Background in payment posting, denials management, or revenue integrity preferred
- CRCR (Certified Revenue Cycle Representative) or equivalent certification preferred
- Proven track record resolving complex credit balance issues and payment discrepancies
- Comprehensive knowledge of revenue cycle workflows, coordination of benefits, and primary/secondary/tertiary payer determination
- Working knowledge of managed care contracts and reimbursement methodologies and claim adjudication processes
- Strong analytical skills to interpret EOBs, remittances, contracts, and payment documentation
- Familiarity with state escheatment/unclaimed property laws and the CMS 60-day overpayment rule
- Proficiency navigating hospital or physician EHR, PMS, and billing systems
- Familiarity with ERA/EFT processing, clearinghouses, and payer portals preferred
- Advanced Excel proficiency (pivot tables, VLOOKUP, formulas, data analysis)
- Ability to establish and maintain effective working relationships with team members, supervisors, managers, clients, and providers
- Ability to prioritize workload and manage multiple responsibilities in a highly organized, efficient, and effective manner
- Knowledge of HIPAA, billing compliance, CMS regulations, and fraud/abuse regulations.
Benefits
- Access to a 401(k) Retirement Savings Plan.
- Comprehensive Medical, Dental, and Vision Coverage.
- Paid Time Off.
- Paid Holidays.
- Additional benefits, including Pet Care Coverage, Employee Assistance Program (EAP), and discounted services.
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