Overview
This role serves as a technical expert lead for the Credit Balance Resolution team, responsible for training new and existing staff and performing all duties of a Credit Balance Resolution Specialist. The position requires independent judgment and decision-making to ensure timely completion of Medicare quarterly credit balance reports, governmental credit balance audits, and unclaimed property processes. It also provides leadership and direction in daily credit balance workflow functions and assists in creating, implementing, and updating policies and procedures.
Responsibilities
- Provide general assistance and leadership to the Credit Balance team.
- Train new staff and provide ongoing training for existing staff.
- Monitor Credit Balance staff activities to ensure timely and accurate reconciliation of credit balances, undistributed payments, and refund requests.
- Complete quality improvement and productivity activities.
- Address questions regarding team functions and assist with team direction.
- Review credit balances, undistributed payments, and refund requests to determine appropriate actions.
- Initiate refunds to patients, guarantors, insurance companies, and other third parties following established procedures, contractual obligations, and regulatory requirements.
- Review refund requests from payers with contracted recoupment language to reduce future reconciliations.
- Review, validate, and correct account adjustments based on insurance reimbursement, benefit coverage, contracted payers, and services provided.
- Redistribute and transfer payments between professional and hospital billing accounts.
- Validate and update patient demographic and insurance information to ensure claim accuracy.
- Reconcile misdirected and clearing accounts by researching and posting payments correctly.
- Ensure correct reimbursement rates are reflected in refund requests.
- Maintain accurate system documentation with notes and standard note codes.
- Adhere to compliance plans and all applicable local, state, and federal regulations.
- Review and resolve assigned accounts daily as directed by management.
- Support the Manager as needed.
Requirements
Education and Experience
- High school diploma or equivalent required.
- Associate Degree in Business, Finance, Health Information Management, or three years of healthcare revenue cycle or clinic operations leadership experience with progressive responsibilities.
- Minimum of five years of experience in insurance, finance, medical office, or customer service-related fields.
- Knowledge of managed care contract billing guidelines.
- Experience in healthcare revenue cycle, financial, or insurance environments.
- Experience with Epic software.
- Knowledge of medical and insurance terminology, CPT, ICD, and HCPCS coding structures, and billing forms (UB, 1500).
Skills and Abilities
- Effective interpersonal skills with the ability to promote teamwork.
- Excellent time management skills; able to handle multiple tasks efficiently while maintaining professionalism.
- Basic math skills and understanding of general accounting principles.
- Strong customer service orientation.
- Ability to work collaboratively with others.
- Strong verbal and written communication skills.
- Detail-oriented and organized.
- High integrity and ability to maintain confidentiality.
- Good judgment and leadership skills, including handling confrontations professionally.
- Proficiency in internal automation and software applications.
Additional Skill Set
- Strong problem-solving, quantitative, analytical, and organizational skills.
- Advanced understanding of Explanation of Benefits (EOB).
- Knowledge of CPT, ICD-10, and HCPCS coding standards.
- Understanding of CMS memos and transmittals.
- Proficient with computer technology.
- Ability to communicate effectively both orally and in writing.
- Ability to manage multiple tasks efficiently.
- Self-starter with willingness to try new ideas.
- Ability to work independently and focus on results.
- Understanding of insurance terms and payment methodologies.
Compensation and Benefits
- Pay range: $18.38 - $26.79 per hour.
- Remote role based out of Greenville, NC.
- Monday through Friday day shift.
- Comprehensive benefits package.
Location
- Remote position based in Greenville, North Carolina.