Credit Balance Specialist

Job Summary

The Credit Balance Specialist reviews patient accounts with Credit Balances and determines appropriate actions to resolve.  Responsible for determining if payment was accurate or if money is due back to payer or patient/guarantor. Coordinates Credit Balance resolution between operational and finance departments.   

Job Responsibilities

• Resolves Credit Balances by determining if reimbursement was accurate and taking appropriate actions.
• Issues refunds to payers and patients, as deemed appropriate after research.
• Promptly resolves requests for refunds by patients and payers after appropriate actions are taken to validate.
• Looks for ways to bulk like issues together to resolve as a project in order to work efficiently.
• Performs any necessary account adjustments or refunds in accordance with department, organization or government/state policies/guidelines.
• Looks for trends with Credit Balances and provides feedback to supervisor in order to prevent future Credit Balances from happening, if avoidable.
• Ensures assigned work queues are reviewed and resolved timely.
• Other duties as assigned.

Education Requirements

• High school diploma or GED

Experience Requirements

• Minimum: One (1) year of experience with insurance balances in a business office or similar role
• Preferred:  Two (2) years of experience with insurance reimbursement with at least 1 year handling Credit Balance and refunds

License/Certification Requirements

• Minimum: None