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This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Credit Balance Specialist in India.
This role is focused on managing complex credit balance cases within a high-volume healthcare revenue cycle environment, ensuring accurate resolution of overpayments and prevention of inappropriate refunds. You will analyze patient accounts across hospital and physician portfolios, working through multi-payer scenarios and applying deep knowledge of reimbursement rules, coordination of benefits, and contractual arrangements. The position requires strong analytical judgment to independently validate refund decisions and resolve discrepancies at the root cause level. You will collaborate closely with payment posting, AR, and patient financial teams to ensure financial accuracy and compliance. Operating in a metrics-driven environment, you will be expected to maintain high standards of productivity, quality, and documentation. This is a detail-intensive role where precision, accountability, and healthcare revenue expertise directly impact financial integrity.
Accountabilities:
- Analyze patient accounts with credit balances to validate overpayments using EOBs, remittance advices, payment history, and contractual reimbursement rules.
- Identify and resolve root causes of credit balances such as posting errors, duplicate payments, COB issues, unapplied cash, and adjustment discrepancies.
- Review and validate refund requests and payer takeback notifications to ensure compliance with contracts and prevent incorrect refunds.
- Research and reconcile unapplied payments by matching remittances, deposits, and account records to ensure accurate allocation.
- Manage complex multi-payer scenarios including Medicare/Medicaid crossovers, workers’ compensation, and third-party liability cases.
- Process refunds in compliance with state escheatment laws, CMS guidelines, and federal overpayment regulations.
- Coordinate with AR follow-up, payment posting, and revenue integrity teams to resolve issues at the source.
- Document all case activity clearly and maintain compliance with HIPAA, CMS, and billing regulations.
- Maintain productivity, accuracy, and turnaround standards in a high-volume operational environment.
Requirements:
- High school diploma or GED required; additional healthcare or finance education is a plus.
- 4–7 years of experience in hospital or physician revenue cycle operations with credit balance resolution experience.
- Strong understanding of coordination of benefits, payer sequencing, and reimbursement methodologies.
- Experience with UB-04 and/or CMS-1500 billing processes preferred.
- Background in payment posting, denials, or revenue integrity operations is highly desirable.
- Strong analytical skills with the ability to interpret EOBs, remittance advice, and payer contracts.
- Proficiency in healthcare billing systems, EHR/PM platforms, and payer portals.
- Advanced Excel skills including formulas, pivot tables, and data analysis.
- Knowledge of HIPAA, CMS regulations, and healthcare compliance frameworks.
- Strong communication, organizational, and multitasking abilities in a deadline-driven environment.
Benefits:
- Competitive compensation aligned with industry standards
- Remote work flexibility depending on operational requirements
- Comprehensive medical, dental, and vision insurance coverage
- Paid time off and paid holidays
- 401(k) retirement savings plan
- Employee assistance program (EAP) and wellbeing support
- Additional perks such as pet care coverage and discounted services
- Inclusive and collaborative workplace culture focused on growth and belonging
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