Credit Balance Specialist

The Credit Balance Specialist analyzes all credit balances before a refund or adjudication is considered and/or processed. The Credit Balance Specialist performs duties while remaining compliant to all CMS and WellStreet Compliance guidelines. This position requires detailed analysis and critical thinking to determine what is necessary to correct an account. This position must have knowledge of insurance and coordination of benefits within the healthcare setting. Customer service, organizational and communication skills are essential to this position. This position requires an ability to prioritize multiple tasks simultaneously in an occasionally stressful environment. This position also requires strong computer skills, typing & ten-key skills and a working knowledge of HIPAA guidelines.

Responsibilities

• Post missing non-EDI payments, contractual allowances, rejection codes, deductibles, and copayments to balance; Review posting errors and apply necessary corrections
• Update and maintain all logs and spreadsheets used for reconciliation
• Maintain or exceed established productivity goals and quality standards
• Manage daily credit refund work queues
• Determine the most efficient process to resolve refund requests and credit balances
• Maintain current knowledge of insurance policies and processes and work with payers to understand and adopt workflows to manage cash application effectively
• Utilize all available resources (EOBs, Waystar, Change, payor websites, Availity, etc.) to ensure refunds/take-backs (recoupments) are adjudicated correctly
• Notify payors of initiated takebacks and submit to management for prior approval
• Update Epic to ensure proper documentation for refunds and maintain optimal payer mapping
• Proactively recognize, report, and resolve trends in revenue recognition
• Identify trends and recommendations to improve revenue cycle processes
• Conduct research and ad-hoc analysis to support revenue cycle goals
• Communicate across teams, providing analytical overviews on key metrics
• Partner with finance, client sites, internal and external billing team to ensure complete billing system and bank reconciliation
• Assist, as needed, with any other business needs
  
  

Minimum Qualifications

• 3 years working with patient accounts
• High School Diploma
• Some college preferred
  
  

Required Skills

• Critical thinking with demonstrated ability to identify root cause of issues and follow-through to resolve
• Advanced knowledge of insurance payers, and the AR/revenue billing lifecycle
• Excellent Computer skills - expertise in MS word suite including Word, Excel, and PowerPoint.
• Experience in using one or more Practice Management Systems/Billing Software; EPIC preferred
• Clear understanding of the impact of payment applications and credit processing has on RCM operations and financial performance
• Ability to work within a team environment and maintain a positive attitude
• Excellent documentation, verbal, and written communication skills
• Extremely organized with a strong attention to detail
• Self-motivated, dependable, and flexible with the ability to handle periods of stress and pressure