RCM Revenue Cycle Specialist, Credit Balance Review

Dental Care Alliance•, FL

About The Position

The RCM Revenue Cycle Specialist, Credit Balance Review audits and validates ledger credit balances aged 30 or more days when no future appointment is scheduled. The Specialist determines each credit’s root cause and drives it to the appropriate resolution, such as correction, transfer, payer recoupment, patient or insurance refund, or unclaimed property processing. The role also supports the refund and unclaimed property lifecycle by documenting and initiating refunds, responding to payer overpayment requests, and conducting research and due diligence before funds are escheated to the state. The Specialist works closely with the Refunds team, Mail team, CBO Posting teams, and practices to ensure credits are handled accurately, compliantly, and within required timeframes. The role uses multiple revenue-cycle and service platforms, responds to internal requests within established SLAs, and contributes to training, documentation, and process improvements. Performance expectations include working at least 10 accounts per hour, maintaining a 20% recovery rate, clearing at least 95% of accounts within required timeframes, and completing refund validation and unclaimed property due diligence accurately and on time.

Requirements

High school diploma or equivalent.
Strong attention to detail, accuracy, and documentation habits.
Strong analytical and research skills, including the ability to trace payments and adjustments across ledgers and payer remittance.
Proficiency with Microsoft Office and comfort working across multiple systems.
Ability to manage a high-volume workload with competing deadlines.

Nice To Haves

Experience in dental or healthcare revenue cycle, payment posting, credit balance review, or refunds.
Familiarity with Denticon, DentalXChange, or similar practice management and clearinghouse platforms.
Familiarity with unclaimed property, escheatment concepts, and due diligence requirements.

Responsibilities

Review and validate ledger credit balances aged 30 or more days with no future appointment scheduled across assigned offices, using the CBR Application and Denticon.
Research each credit’s source, including duplicate or misapplied payments, insurance overpayments, posting errors, adjustments, or payments applied to the wrong patient, provider, or office.
Resolve credits through corrective transfers, adjustments, or payment reapplication, coordinating with CBO Posting teams and practices when their action is required.
Participate in review rotations to ensure high-, moderate-, and low-risk credit balances are reviewed consistently within the established review cycle.
Document findings, actions, and outcomes in the CBR Application, Denticon, and the applicable tracker.
Identify recurring root causes and trends and escalate them to the Revenue Cycle Manager, Practice Support Services.
Initiate refund requests and FreshService tickets for confirmed patient and insurance overpayments, attaching supporting documentation.
Review refund tickets for accurate Denticon data, payee, address, amount, and the absence of other outstanding balances or pending account activity.
Audit and validate patient-ledger credits against payments, adjustments, payer remittance, and the correct office charge.
Confirm required documentation, including EOB/ERA, payer correspondence, and approvals, is present before a refund is released for processing.
Flag validated refund tickets as good to process and hand them off to the Refunds team; return incomplete or inaccurate tickets to requestors with clear notes.
Review and complete insurance refund documentation and respond to payer overpayment and recoupment requests in coordination with the Refunds team.
Support payer refund and recoupment follow-up, including tracking checks issued, voided, returned, or reissued.
Post third-party finance fees and refunds as assigned, following established procedures.
Partner with the Refunds team to ensure completed refund requests are handed off cleanly and minimize reissues through accurate upfront review.
Identify credit balances that cannot be refunded or resolved through normal outreach and determine whether they meet unclaimed property criteria under applicable state requirements and DCA policy.
Review and maintain the UCP log, ensuring items are accurately entered, categorized, and updated with current status.
Perform and document required unclaimed-property due diligence, including address research, outreach letters, and contact attempts, within applicable state timeframes.
Research and resolve returned UCP letters and undeliverable refund checks, updating patient information and status as appropriate.
Route UCP credit balances and letters ready for reporting or remittance to the Refunds team with complete documentation.
Escalate state-specific questions, disputed claims of ownership, and exceptions to the Revenue Cycle Manager, Practice Support Services.
Use Denticon, DentalXChange (DXC), Zentist, the CBR Application, Ryan Tracker Pro, FreshService, and the Recon Portal as applicable, following established workflows and documentation standards.
Respond to FreshService tickets and internal requests within established SLAs.
Participate in team meetings, training, and cross-training to provide coverage across credit balance, refund, and UCP workflows.
Contribute to SOPs, job aids, and process improvements for credit balance, refund, and unclaimed property workflows.
Adhere to HIPAA guidelines, payer rules, and internal compliance protocols while maintaining clean, audit-ready documentation.