The Credit Balance Manager for hospital and clinic operations is responsible for managing, analyzing, and resolving credit balances on patient accounts to ensure accurate financial reporting and compliance with healthcare regulations. This role supports the revenue cycle by collaborating closely with patient financial services, billing, and clinical departments to resolve credit balances arising from overpayments, billing discrepancies, or insurance adjustments. The manager will lead a team dedicated to credit balance resolution while promoting efficient refund processes and preventing future credit occurrences across both inpatient and outpatient services.
MINIMUM QUALIFICATIONS
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Bachelor’s degree in Healthcare Administration, Finance, Accounting, or related field preferred .
OR
2. High School Diploma and 10 years of experience in HealthCare Revenue Cycle.
EXPERIENCE:
1. 5 years of experience in healthcare revenue cycle, accounts receivable, or credit balance management within hospital and outpatient clinic settings.
2. Familiarity with hospital billing systems (e.g., Epic, Cerner) and outpatient practice management software.
3. Five (5) plus years of demonstrated leadership experience managing teams in a fast-paced healthcare environment.
PREFERRED QUALIFICATIONS
EXPERIENCE:
1. Prior Credit Balance management experience.
CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.
1. Monitor credit balances from various revenue sources, including inpatient hospital stays, outpatient clinics, emergency services, and ancillary departments.
2. Conduct thorough investigations into credit balances, identifying causes such as duplicate payments, insurance overpayments, patient refunds, or billing errors.
3. Collaborate with patient access, billing, clinical departments, and insurance payers to reconcile and resolve credit balances accurately and timely.
4. Supervise and mentor a team responsible for credit balance research and resolution in hospital and clinic settings.
5. Partner with revenue cycle management, patient financial counseling, and compliance teams to streamline credit balance workflows.
6. Provide training to billing and clinical staff on credit balance prevention and resolution best practices.
7. Ensure adherence to federal and state healthcare regulations including CMS guidelines, HIPAA, and payer contract requirements related to credit balance management.
8. Maintain accurate documentation for audit readiness and internal control reviews within hospital and outpatient operations.
9. Develop and enforce internal controls and policies to prevent recurring credit balances.
10. Generate and analyze reports detailing credit balance volumes, aging, and resolution trends across hospital and clinic revenue streams.
11. Present findings and strategic recommendations to finance and revenue cycle leadership.
12. Use data analytics to identify systemic issues and propose process improvements to reduce credit balance occurrences.
13. Oversee the refund process for patients and payers, ensuring compliance with hospital policies and regulatory requirements.
14. Reconcile credit balances with hospital and clinic general ledger accounts to support accurate financial statements.
15. Coordinate with finance and accounting teams for proper documentation and timely refund disbursement.
PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Ability to sit for long periods of time.
2. Ability to lift, push or pull 10–15 pounds.
WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Work from home.
2. Standard office environment.
SKILLS AND ABILITIES:
1. Excellent analytical, communication, and interpersonal skills.
2. In-depth understanding of regulatory compliance including CMS, HIPAA, and False Claims Act as applied to hospital and outpatient billing.
3. Ability to manage multiple priorities and deadlines while maintaining accuracy.
4. Strong knowledge of hospital and clinic billing processes, payer contracts, and healthcare reimbursement regulations.
Additional Job Description:
Scheduled Weekly Hours:
40
Shift:
Day (United States of America)
Exempt/Non-Exempt:
United States of America (Exempt)
Company:
SYSTEM West Virginia University Health System
Cost Center:
663 SYSTEM Cash Management
The West Virginia University Health System, which operates under the brand WVU Medicine, is West Virginia’s largest health system and the state’s largest employer with more than 3,400 licensed beds, 4,600 providers, 35,000 employees, and $7 billion in total operating revenues. The Health System is comprised of 25 hospitals – including J.W. Ruby Memorial Hospital, an 880-bed academic medical center, and the 150-bed WVU Medicine Golisano Children’s Hospital in Morgantown, West Virginia – and five institutes. To learn more, visit WVUMedicine.org.
