Credit Balance Specialist (51435)
Summary
Credit Balance Specialist handling patient and insurance account reconciliation for a dermatology clinic network. Reviews credit balances, investigates overpayments, processes refunds per regulatory requirements, and ensures compliance with HIPAA, Medicare, Medicaid, and payer contracts. Works in the Dallas Practice Support Center coordinating with billing, coding, and collections teams.
Who We Are:
Platinum Dermatology Partners is a network of high-quality dermatology clinics that focus on collaborative and innovative ideas to drive growth. We offer general dermatology, cosmetic, medical, plastic surgery, and cancer screening treatments. We have over 145 clinics, over 350 providers, and more than 2300 employees in clinics across Texas, Arizona, California, Nevada, and Florida. We are a rapidly growing company that allows our doctors to focus on providing exceptional care without worrying about the operational side of the business. Our core values focus on collaboration, ownership, respect, excellence, authenticity, and integrity. Our purpose is to empower the practice of exceptional dermatology.
Company Conformance Statements:
In the performance of their respective tasks and duties, all employees are expected to conform to the following:
- Perform quality work within deadlines with or without direct supervision.
- Interact professionally with other employees, customers, and suppliers.
- Work effectively as a team contributor on all assignments.
- Work independently while understanding the necessity for communicating and coordinating work efforts with other employees and organizations.
Position Summary: Responsible for identifying, researching, resolving, and processing credit balances within patient and insurance accounts to ensure compliance with payer contracts, government regulations, and organizational policies. This role works closely with insurance companies, patients, and other revenue cycle departments to investigate overpayments, process refunds, and maintain accurate account balances.
Principal Duties and Responsibilities:
- Review patient accounts with credit balances and determine the root cause of overpayments.
- Investigate and resolve credit balances resulting from payer overpayments, duplicate payments, contractual adjustments, billing errors, patient payments, and other discrepancies.
- Process refunds to insurance carriers, government payers, and patients in accordance with regulatory requirements and organizational policies.
- Ensure timely resolution of credit balances to meet compliance standards and avoid financial penalties.
- Research payer contracts, explanation of benefits (EOBs), remittance advices, and payment postings to validate account balances.
- Collaborate with billing, collections, payment posting, coding, and customer service teams to resolve account discrepancies.
- Maintain detailed documentation of account research, actions taken, and refund transactions.
- Monitor assigned work queues and prioritize accounts based on aging and compliance requirements.
- Identify trends and recurring issues contributing to credit balances and communicate findings to leadership.
- Assist with internal and external audits by providing documentation and account research.
- Ensure adherence to HIPAA, Medicare, Medicaid, commercial payer regulations, and organizational policies.
- Meet productivity, quality, and accuracy standards established by management.