Credit Balance Specialist
New
IndiaFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- 4–7 years
- Required Skills
- Microsoft ExcelHIPAA
Requirements
- High school diploma or GED required; additional healthcare or finance education is a plus.
- 4–7 years of experience in hospital or physician revenue cycle operations with credit balance resolution experience.
- Strong understanding of coordination of benefits, payer sequencing, and reimbursement methodologies.
- Experience with UB-04 and/or CMS-1500 billing processes preferred.
- Background in payment posting, denials, or revenue integrity operations is highly desirable.
- Strong analytical skills with the ability to interpret EOBs, remittance advice, and payer contracts.
- Proficiency in healthcare billing systems, EHR/PM platforms, and payer portals.
- Advanced Excel skills including formulas, pivot tables, and data analysis.
- Knowledge of HIPAA, CMS regulations, and healthcare compliance frameworks.
- Strong communication, organizational, and multitasking abilities in a deadline-driven environment.
Responsibilities
- Analyze patient accounts with credit balances to validate overpayments using EOBs, remittance advices, payment history, and contractual reimbursement rules.
- Identify and resolve root causes of credit balances such as posting errors, duplicate payments, COB issues, unapplied cash, and adjustment discrepancies.
- Review and validate refund requests and payer takeback notifications to ensure compliance with contracts and prevent incorrect refunds.
- Research and reconcile unapplied payments by matching remittances, deposits, and account records to ensure accurate allocation.
- Manage complex multi-payer scenarios including Medicare/Medicaid crossovers, workers’ compensation, and third-party liability cases.
- Process refunds in compliance with state escheatment laws, CMS guidelines, and federal overpayment regulations.
- Coordinate with AR follow-up, payment posting, and revenue integrity teams to resolve issues at the source.
- Document all case activity clearly and maintain compliance with HIPAA, CMS, and billing regulations.
- Maintain productivity, accuracy, and turnaround standards in a high-volume operational environment.
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