CRMG Billing Credit Specialist

Cheyenne Regional Medical Center•Cheyenne, WY

14d•Onsite

About The Position

The CRMG Billing Credit Specialist is responsible for reviewing, reconciling, and resolving credit balances and payer-related variances to ensure accurate reimbursement and regulatory compliance. This role focuses on managing overpayments, underpayments, and audit-related activity while supporting revenue cycle operations, enhancing the patient's financial experience, and minimizing organizational risk.

Requirements

High school diploma (or Equivalent Certificate from an accredited program) or higher degree
Two (2) or more years of experience in healthcare billing or revenue cycle operations
Strong analytical and critical thinking skills with the ability to resolve complex financial discrepancies
In-depth knowledge of healthcare billing, payer reimbursement, and audit processes
Ability to perform with high attention to detail with a focus on accuracy in financial reconciliation
Strong communication and collaboration skills across departments and external stakeholders
Working knowledge of payer guidelines, contracts, and reimbursement methodologies
Knowledge of denial management and appeals processes
Ability to manage multiple priorities and meet deadlines in a fast-paced environment
Knowledge of Medicare, Medicaid, and commercial payer requirements

Nice To Haves

Two (2) or more years of experience with electronical medical records (EMR) and billing systems

Responsibilities

Reviews and resolves accounts with credit balances to ensure timely and accurate disposition of funds in accordance with organizational policies and payer requirements.
Analyzes overpayment and underpayment variances within assigned work queues and initiate appropriate corrective actions.
Communicates with patients regarding refunds, or payment transfers to ensure transparency and accurate financial tracking.
Partners with leadership to identify audit trends and proactively communicate potential risks to clinics, leadership, the Real Time Eligibility (RTE) Payer Committee, and payer representatives to reduce future refund liability and improve patient experience.
Monitors, tracks, and manages payer audit activities, including Additional Documentation Requests (ADR), Comprehensive Error Rate Testing (CERT), Recovery Audit Contractor (RAC), and demand letter correspondence.
Investigates payer discrepancies and collaborate with Compliance to resolve complex account issues and denials.
Ensures thorough and accurate account documentation in compliance with regulatory and organizational standards, meeting departmental productivity and quality benchmarks.
Reviews payer policies and reimbursement methodologies to ensure accurate billing practices and payment posting.
Prepares and submits claims (electronic and paper) to commercial and government payers, including management of claim edits and work queues.
Maintains and expands knowledge of healthcare reimbursement regulations, supporting continuous improvement initiatives within the revenue cycle.