Credit Balance Specialist

🔥 6 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Infinx

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

⚕️ Healthcare Insurance

☁️ SaaS

🤖 Artificial Intelligence

💰 Venture Round on 2021-11

Healthcare Insurance • SaaS • Artificial Intelligence

Infinx is a company that specializes in optimizing the healthcare revenue cycle through advanced technology solutions. It offers a comprehensive platform that automates and enhances processes such as prior authorizations, eligibility verifications, medical coding, billing, and revenue acceleration. By leveraging artificial intelligence, automation, and integrations within healthcare systems, Infinx helps healthcare providers streamline patient access and maximize reimbursements. The company works closely with healthcare providers, including hospitals, physician groups, and specialty centers, to address their revenue cycle challenges effectively. Infinx's solutions aim to reduce denials, improve claim accuracy, and enhance patient satisfaction, thereby allowing providers to focus more on delivering high-quality care.

📋 Description

• Analyze patient accounts with credit balances, validating overpayment accuracy by evaluating EOBs, remittance advices, payment history, COB sequencing, and expected reimbursement before processing any refund • Identify root causes of credit balances including posting errors, duplicate payments, COB failures, contract variances, unapplied cash, and incorrect adjustments • Validate refund requests and takeback notifications from third-party payers against contracts, payment history, and claim adjudication to prevent inappropriate refunds • Research and resolve unapplied payments by reconciling remittance advices, deposits, and account histories to allocate funds to the correct accounts • Investigate complex multi-payer scenarios involving Medicare/Medicaid crossovers, third-party liability, workers' compensation, motor vehicle accident, and secondary/tertiary billing • Make independent, defensible decisions on challenging cases requiring interpretation of payer contracts, billing regulations, and revenue cycle policy • Coordinate with payment posting, AR follow-up, contract management, and patient financial services to resolve account issues at the root • Process patient and payer refunds accurately and timely in accordance with state escheatment laws and federal overpayment rules • Communicate professionally with insurance companies, patients, and internal departments regarding credit balance inquiries • Document all account activity and resolution steps with clear, concise, and actionable notes • Maintain productivity and quality standards in a high-volume, deadline-driven environment • Maintain full compliance with HIPAA, billing compliance, CMS regulations, and fraud/abuse regulations • Assignments may shift across client portfolios and credit balance categories based on volume and priority within the scope of the role

🎯 Requirements

• High School Diploma or GED • 4-7 years of hospital and/or physician accounts receivable experience with hands-on credit balance resolution responsibilities • Experience with both facility (UB-04) and professional (CMS-1500) credit balance resolution preferred • Background in payment posting, denials management, or revenue integrity preferred • CRCR (Certified Revenue Cycle Representative) or equivalent certification preferred • Proven track record resolving complex credit balance issues and payment discrepancies • Comprehensive knowledge of revenue cycle workflows, coordination of benefits, and primary/secondary/tertiary payer determination • Working knowledge of managed care contracts and reimbursement methodologies and claim adjudication processes • Strong analytical skills to interpret EOBs, remittances, contracts, and payment documentation • Familiarity with state escheatment/unclaimed property laws and the CMS 60-day overpayment rule • Proficiency navigating hospital or physician EHR, PMS, and billing systems • Familiarity with ERA/EFT processing, clearinghouses, and payer portals preferred • Advanced Excel proficiency (pivot tables, VLOOKUP, formulas, data analysis) • Ability to establish and maintain effective working relationships with team members, supervisors, managers, clients, and providers • Ability to prioritize workload and manage multiple responsibilities in a highly organized, efficient, and effective manner • Knowledge of HIPAA, billing compliance, CMS regulations, and fraud/abuse regulations.

🏖️ Benefits

• Access to a 401(k) Retirement Savings Plan. • Comprehensive Medical, Dental, and Vision Coverage. • Paid Time Off. • Paid Holidays. • Additional benefits, including Pet Care Coverage, Employee Assistance Program (EAP), and discounted services.