Credit Balance Specialist

Infinx•, (Multiple States)

6d•Remote

About The Position

The Credit Balance Resolution Specialist resolves complex credit balance accounts across hospital and physician portfolios while preventing inappropriate refunds. This role requires deep command of coordination of benefits, contractual reimbursement, unapplied payments, and payer takeback rules to ensure accurate resolution in multi-payer scenarios. This role is in a high-volume, metrics-oriented outsourced environment with client-specific productivity and quality targets. The Credit Balance Specialist makes independent, defensible decisions on challenging cases and coordinates with payment posting, AR follow-up, and patient financial services to resolve credit balances at the root.

Requirements

High School Diploma or GED
4-7 years of hospital and/or physician accounts receivable experience with hands-on credit balance resolution responsibilities
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
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

Nice To Haves

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
Familiarity with ERA/EFT processing, clearinghouses, and payer portals preferred
Advanced Excel proficiency (pivot tables, VLOOKUP, formulas, data analysis)

Responsibilities

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