Sr. Patient Account Specialist - Credit Balance

Emerus•Remote,

About The Position

The Sr. Patient Account Specialist – Credit Balance assists the Patient Account Supervisor with patient and third-party payer payments for patient visits. The role manages a designated group of credit-balance accounts and refund requests, ensuring timely and accurate resolution of overpayments and refund requests. This includes researching insurance benefits and coordination of benefits, distributing, reapplying, or transferring payments to the appropriate date of service or account, generating refund requests and overpayment notifications, and denying refund requests when appropriate under established guidelines. The work requires understanding contractual obligations and regulatory requirements. The position works alongside the team and provides direction to less experienced staff in conjunction with the Patient Account Supervisor. It also supports workload assignments, monitors Credit Balance team activity, reviews account adjustments and refund requests, and collaborates with other CBO departments to resolve pending claim activities.

Requirements

High school diploma or GED.
At least 3 years of relevant experience in a provider inpatient or outpatient setting.
Advanced knowledge of claims processing, appeals, medical terminology, accounts receivable, claim forms, claims billing, insurance verification, adjustments and refunds, claims status, and reimbursement.
At least 2 years of previous team leader or supervisory experience, or equivalent.
Advanced knowledge of payer insurance groups, including Medicare, Medicaid, and government managed care.
Experience with medical records or patient accounting systems.
Knowledge and understanding of state and federal payment laws to support prompt and accurate reimbursement.
Advanced knowledge and understanding of healthcare explanations of benefits (EOBs).
Intermediate knowledge of Microsoft Office products, including Outlook, Excel, and Word; Excel experience should include VLOOKUP/XLOOKUP, pivot tables, and basic formulas.
Fluency in English, both written and oral.

Nice To Haves

Previous coaching or training experience and the ability to create training manuals, tools, and materials.

Responsibilities

Assist in assigning staff workloads and reprioritize work as necessary.
Monitor Credit Balance team activities to ensure credit balances and refund requests are reconciled appropriately and on time.
Communicate with payers about overpayments, request recoupment, and void claims with payers when necessary.
Review overpayments, credit balances, and refund requests accurately and promptly.
Review, validate, and correct account adjustments based on insurance reimbursement and coverage, contracted payers, and services provided.
Validate and update patient demographic and insurance information to support accurate future claims.
Initiate refunds to patients or guarantors, insurance companies, and other third parties according to established procedures, contractual obligations, payer requirements, and regulations.
Use online and telephone resources to verify benefits and ensure claims are processed according to appropriate benefit levels.
Review refund requests for accuracy and submit them as appropriate.
Review adjustment requests for accuracy and submit them as appropriate.
Assist with developing and training staff on workflow processes and payer behavior responses as necessary.
Complete special projects and ad hoc claim reviews as assigned by the Supervisor, Director, or CFO.
Work with CBO intra-departments to resolve pending claim activities.
Meet accuracy and productivity goals, including goals related to days in AR and cash collections.
Attend required staff meetings and other company-sponsored or mandated meetings.
Perform additional duties as assigned.