Job Description

Reporting to the Cash Applications Manager, the Credit Balance Specialist will resolve open balances with the goal to prevent future rework. They will analyze EOBs and/or payor correspondence to reconcile system credit balances or potential overpayments, research and resolve problem accounts, and requests adjustments or refunds as needed. They will effectively identify trends and analyze root cause issues to present to the client and leadership team.

Responsibilities:

• Manage daily work queues of credit balances for both onshore & offshore teams.
• Research, initiate follow-up and resolve all health care insurance claim accounts with existing credit balances.
• Complete thorough review of patients’ accounts with credit balances to validate the patient overpayment is accurate.
• Recommend an adjustment when applicable or recommend a refund of the overpayments to the insurance carrier or patient, providing the appropriate documentation.
• Apply knowledge related to insurance contracts, interpret explanation of benefits, understand regulations concerning coordination of benefits and other applicable guidelines.
• Process refunds accurately and in timely manner adhering to contract language where appropriate.
• Navigate through various payer systems and multiple internal systems to ensure timely and accurate resolution of claims.
• Use critical and analytical problem-solving skills to resolve issues
• Uses strong organizational skills to effectively manage large amounts of detailed information
• Utilizes excellent written and oral communication skills to collaborate and maintain positive working relationships with peers, leaders, surgery centers, and payer representatives to resolve credit balances.
• Consistent, regular, punctual attendance as scheduled is an essential responsibility of this position
• Other duties as assigned

Required Experience:

• 2+ years of ASC revenue cycle or orthopedic payment posting or collections experience.
• Ability to read and interpret insurance explanations of benefits and managed care contracts.
• Knowledge or experience working with a variety of health care insurance payers is preferred
• Intermediate computer proficiency in Microsoft Office including Excel and Outlook
• Advantx, Vision, SIS Complete, HST experience preferred.
• High School Diploma or equivalent.