Accounts Receivable Credit Specialist

 

The Accounts Receivable Credit Specialist is responsible for reviewing and resolving insurance credit balances to ensure accurate account reconciliation and regulatory compliance. This role analyzes credit balances to determine appropriate resolutions, including refunds, transfers, adjustments, or contractual allowance corrections. The specialist identifies trends, investigates root causes, and collaborates with cross-functional teams to reduce future credit balances and improve operational efficiency.

Key Responsibilities

• Review, investigate, and resolve insurance credit balances in a timely and accurate manner.
• Research claim payment discrepancies and determine appropriate corrective actions, including rebilling, adjustments, transfers, or refunds.
• Initiate and process identified overpayment refunds in accordance with company policies and payer requirements.
• Prepare and submit refund requests for approval and maintain supporting documentation.
• Manage payer refund disputes and appeals related to inappropriate refund requests.
• Collaborate with the Contracting team, Cash Application team, and other stakeholders to identify and implement necessary posting corrections.
• Determine and execute the appropriate resolution for credit balance inquiries and refund requests.
• Analyze credit balance activity to identify trends, recurring issues, and root causes.
• Report payer processing issues and partner with internal teams to develop corrective action plans.
• Process and respond to payer correspondence related to credit balances, refunds, and account adjustments.
• Ensure compliance with payer contracts, government regulations, and company policies.
• Participate in process improvement initiatives aimed at reducing credit balances and improving reimbursement accuracy.
• Perform additional duties and special projects as assigned.

Education & Experience

Required:

• Bachelor’s degree in business, Healthcare Administration, Finance, Accounting, or a related field preferred; equivalent combination of education and experience will be considered.
• Minimum of five (5) years of healthcare revenue cycle experience, with a focus on accounts receivable, collections, refunds, or credit balance resolution.
• Strong knowledge of commercial and government insurance programs, including Medicare and Medicaid.
• Durable Medical Equipment (DME) experience.

Preferred:

• Experience with Brightree DME software.

 

Knowledge, Skills & Abilities:

• Proficient in Microsoft Office Suite, including Excel, Word, and Outlook.
• Strong analytical, critical thinking, and problem-solving skills.
• Ability to independently research and resolve complex account issues.
• Strong attention to detail with a high degree of accuracy.
• Excellent organizational and time management skills with the ability to prioritize multiple responsibilities.
• Ability to thrive in a fast-paced, dynamic, and growth-oriented environment.
• Demonstrated accountability and ownership of assigned responsibilities.
• Strong interpersonal, written, and verbal communication skills.
• Ability to collaborate effectively across departments and with all levels of the organization.
• Knowledge of insurance payment processing, denials, adjustments, and reimbursement practices.
• Results-oriented with a strong sense of urgency and commitment to meeting deadlines.
• Ability to work independently with minimal supervision while exercising sound judgment.

Core Competencies

• Change Agility
• Integrity and Trust
• Communication
• Influencing and Collaboration
• Planning and Organization
• Data Analysis and Reporting
• Priority Setting
• Problem Solving
• Accountability

Success Measures

• Timely resolution of assigned credit balances.
• Accuracy and compliance of refund processing.
• Identification and reduction of recurring credit balance issues.
• Effective collaboration with internal departments and external payers.
• Achievement of productivity and quality goals established by leadership.