The Onyx Group - Credit Specialist

Tribe513 | The Onyx Group•Greenville, SC

3d•Onsite

About The Position

The Credit Specialist (Insurance & Patient) is responsible for the timely and accurate resolution of credit balance accounts across both patient and payer populations. This position reviews and resolves overpayments, processes refunds, performs account reconciliations, and ensures compliance with payer, regulatory, and organizational requirements. The Credit Specialist works collaboratively with Revenue Cycle teams to identify and resolve credit balances, maintain account accuracy, and support financial integrity throughout the revenue cycle.

Requirements

High School Diploma or equivalent required.
Knowledge of insurance payment methodologies and Explanation of Benefits (EOB) interpretation.
Understanding of credit balance workflows and refund processes.
Strong analytical and problem-solving skills.
Excellent attention to detail and accuracy.
Effective organizational and time management skills.
Ability to work independently and manage assigned workloads.
Strong written and verbal communication skills.

Nice To Haves

Associate's or Bachelor's degree preferred.
1–3 years of Revenue Cycle experience preferred.
Experience with credit balance resolution, refund processing, cash posting, AR follow-up, or related revenue cycle functions preferred.
Experience with Epic, eCW, or other healthcare billing systems preferred.
Certified Revenue Cycle Representative (CRCR) or willingness to obtain.

Responsibilities

Maintain an assigned inventory of credit balance accounts, including both insurance and patient credits.
Review and resolve insurance and patient overpayments in accordance with payer and organizational guidelines.
Process payer and patient refunds accurately and within required timeframes.
Transfer or reallocate credit balances when appropriate.
Post adjustments as required to properly reconcile accounts.
Research account activity to determine the root cause of credit balances.
Document account findings, actions taken, and resolution outcomes thoroughly and accurately.
Ensure all assigned accounts are resolved in a timely and compliant manner.
Review and reconcile credit balance accounts to determine appropriate disposition.
Process refunds, adjustments, transfers, takebacks, recoupments, and offsets as applicable.
Verify that account balances accurately reflect payment activity and adjustments.
Monitor assigned inventory to ensure aging standards and productivity expectations are met.
Escalate complex or unresolved issues to leadership as appropriate.
Adhere to CMS, payer, and organizational refund requirements and timelines.
Maintain compliance with HIPAA and all applicable privacy and security regulations.
Ensure accurate documentation of account activity and resolution actions.
Support internal and external audit requests by providing appropriate account documentation.
Maintain productivity and quality standards established by Revenue Cycle leadership.
Review work for accuracy and completeness prior to final resolution.
Identify trends or recurring issues contributing to credit balances and communicate findings to leadership.
Participate in quality improvement initiatives designed to reduce credit balances and improve operational efficiency.
Work collaboratively with Cash Posting, AR Follow-Up, Denials & Appeals, Patient Financial Services, and Revenue Cycle Leadership.
Communicate account issues requiring additional review or intervention.
Assist with resolution of account discrepancies impacting credit balance processing.