Credit Balance Specialist

Amerita

Amerita is a leading provider of Specialty Infusion services focused on providing complex pharmaceutical products and clinical services to patients outside of the hospital. As one of the most respected Specialty Infusion providers in America, we service thousands of patients nationwide through our growing network of branches and healthcare professionals.

The Credit Balance Specialist II is responsible for facilitating the resolution of insurance and patient credit balances by researching to determine whether the refund is appropriate, a payment transfer/offset is needed, or a contractual adjustment is warranted in accordance with applicable state/federal regulations and company policies. The Credit Balance Specialist works closely with other staff to identify, resolve, and share information regarding payer trends and provider updates. The employee must have the ability to prioritize, problem solve, and multitask.

Mon - Fri 7:00a - 3:30p Mountain Time - fully remote.

Ensures daily accomplishments by working towards individual and company goals for cash collections, credit balances, medical records, correspondence, appeals/disputes, accounts receivable over 90 days, and other departmental goals
• Understands and adheres to all applicable state/federal regulations and company policies
• Understands insurance contracts in terms of medical policies, payments, patient financial responsibility, credit balances, and refunds
• Verifies dispensed medication, supplies, and professional services were billed accurately. Validates reimbursement is correct and the appropriate deductible and cost share amounts billed to the patient per the payer remittance advice.
• Reviews remittance advices, payments, adjustments, insurance contracts/fee schedules, insurance eligibility and verification, and assignment of benefits to determine the correct credit classification
• Initiates and coordinates offsets and cash research requests with the cash applications department and conducts accurate payment transfers in accordance with established processes. Reverses or completes necessary adjustments within approved range.
• Utilizes approved credit categorization criteria and note templates to ensure accurate documentation in CPR+
• Creates patient refund packets and validates receipt of previously submitted payer disputes
• Works within established departmental goals and performance/productivity metrics
• Identifies and communicates issues and trends to management

• High School diploma/GED or equivalent required; some college a plus
• A minimum of one to two (1-2) years of experience in revenue cycle management with a working knowledge of Managed Care, Commercial, Government, Medicare, and Medicaid reimbursement
• Working knowledge of automated billing systems; experience with CPR+ and Waystar a plus
• Working knowledge and application of metric measurements, basic accounting practices, ICD 9/10, CPT, HCPCS coding, and medical terminology
• Solid Microsoft Office skills with the ability to type 40+ WPM
• Strong verbal and written communication skills with the ability to independently obtain and interpret information
• Strong attention to detail and ability to be flexible and adapt to workflow volumes
• Knowledge of federal and state regulations as it pertains to revenue cycle management a plus
• Flexible schedule with the ability to work evenings, weekends, and holidays as needed