Job Details

Patient & Insurance Credit Balance Specialist

The Patient & Insurance Credit Balance Specialist is responsible for the accurate review, analysis, and resolution of credit balances within the revenue cycle. This role ensures timely identification and processing of patient and payer overpayments, compliance with regulatory requirements, and maintenance of accurate financial records. This position plays a critical role in minimizing financial risk, ensuring compliance, and supporting an optimal patient financial experience.

Key responsibilities include:

• Review and analyze patient and insurance credit balance accounts to determine root cause of overpayments
• Process patient and payer refunds in accordance with organizational policies and regulatory guidelines
• Identify trends and escalate systemic issues contributing to credit balances
• Generate and manage overpayment correspondence to insurance carriers
• Review and respond to payer refund requests and recoupments
• Ensure compliance with CMS, Medicare, Medicaid, and commercial payer guidelines
• Maintain accurate documentation of all actions taken on accounts
• Reconcile accounts and ensure proper adjustment posting where applicable
• Support month-end and quarterly reporting (e.g., credit balance reporting)
• Collaborate with billing, coding, cash posting, and denial teams to resolve discrepancies
• Meet productivity, quality, and turnaround time standards
• Maintain HIPAA compliance and patient confidentiality at all times

Minimum qualifications include:

• High School Diploma or GED required
• 13 years of experience in healthcare revenue cycle, billing, AR, or cash posting
• Basic understanding of insurance reimbursement and overpayment processes
• Strong attention to detail and analytical skills
• Proficiency with Microsoft Office (especially Excel)
• Ability to work onsite in a fast-paced, team-oriented environment

Preferred qualifications include:

• Experience with Epic and/or eClinicalWorks (ECW)
• Experience with physician billing (PB) workflows
• Knowledge of CMS credit balance regulations and refund timelines
• Certified Revenue Cycle Representative (CRCR) or willingness to obtain
• Experience with payer portals and refund processing systems

Key competencies include:

• Strong problem-solving and critical thinking skills
• High level of accuracy and accountability
• Effective communication with internal teams and external payers
• Time management and ability to prioritize workload
• Customer-service mindset when addressing patient-related balances

Work environment includes:

• Fully onsite position
• Standard business hours with occasional overtime based on business needs
• Collaborative revenue cycle team environment

Performance metrics include:

• Credit balance resolution turnaround time
• Refund processing accuracy and timeliness
• Productivity (accounts reviewed per day/week)
• Compliance with regulatory and internal audit standards

The Onyx Group is an Equal Opportunity Employer