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Credit Balance Specialist

Englewood, CO

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  • nsure daily accomplishments work towards company goals for credit balances, cash collections and A/R over 90 days
  • Understand and adhere to state and federal regulations, and to company policies regarding  compliance, integrity, patient privacy and ethical billing and collection practices
  • Understand and adhere to HIPAA and PHI guidelines
  • Understand all aspects of insurance contracts in terms of payments, patient financial responsibility, credit balances, and refunds
  • Review residual account balances after payments are applied and generates necessary adjustments (within eligible guidelines), overpayment notifications, refund requests, corrected claims, and secondary billings as needed.  . Assesses and transfers patient balances per remittance advices. 
  • Receive refund and recoupment requests from payers.  Communicates financial concepts pertaining to home infusion contracts, fee schedules, and medical benefits in order to dispute refund requests and recoupments with payers or third party collection agencies
  • Utilize approved note templates and documents all actions taken in CPR+ for RCM analyst tracking purposes
  • Initiate and coordinate move and cash research requests with the cash applications department
  • Complete credit rebill requests and works with appropriate Billing and/or Collection Specialists when primary claims must be resubmitted as a result of clearing up residual credit balances
  • Utilize most efficient resources to secure timely resolution of credit invoices or balances; electronic solutions should be given priority
  • Identify patterns of over payments and brings them to the attention of the appropriate supervisory personnel; identifies billing errors, inaccurate payments, posting errors and resolves accordingly communicating any needed system changes or training opportunities
  • Communicate consistently and professionally with other employees, payers, and third party collection agencies
  • Adhere to established performance metric for the Credit Balance Specialist
  • Work within specified deadlines and stressful situations
  • Work overtime when necessary to meet department goals and objectives
  • Perform other tasks or special projects as requested by management

Job Requirements

  • High School diploma or GED equivalent required. 
  • College or post-secondary education a plus
  • A minimum of 1-2 years experience in medical collections with a working knowledge of managed care, commercial insurance, Medicare and Medicaid reimbursement;  home infusion experience a plus
  • Working knowledge of automated billing systems, experience with CPR+ and Zirmed preferred
  • Working knowledge and application of metric measurements, basic accounting practices, ICD-9/10, CPT and HCPCS coding
  • Solid Microsoft Office skills required: Word, Excel and Outlook
  • Ability to type 40 wpm and proficiency with10-key calculator
  • Medical Terminology preferred
  • Ability to independently obtain and interpret information
  • Strong verbal and written communication skills; ability to draft/write professional business correspondence
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