Insurance Credit Specialist

Role Overview

• Review and analyze accounts and/or credit balance reports from insurance carriers and patients.
• Review explanation of benefits, contact insurance carriers for additional information.
• Communicate with insurance carriers to gather information.
• Resolve both patient & insurance credit balance refunds.
• Research and resolve unapplied cash activity accounts.
• Document any request or concern received via mail, e-mail, telephone, written correspondence, or in person on the patient’s account.
• Responsible for responding to insurance companies & patient requests for refunds in a timely manner (within 30 days).
• Identify the originating cause of the need for a refund and compile a report of recurring issues to management.
• Responsible for correcting errors in the calculation and posting of insurance contractual adjustments.
• Maintain confidentiality of all protected health information (PHI).

Requirements

• High school graduate or equivalent (GED) required.
• Associate degree or bachelor’s degree in healthcare administration or another related field preferred.
• Experience with analyzing explanation of benefits (EOBs) from various insurance companies/payers.
• One year of experience in insurance billing/insurance follow up for Medicare, Medicaid, commercial payers required.
• Medical terminology knowledge preferred.
• Knowledge of CPT / ICD-10 coding.

Benefits

• Comprehensive Benefits: Multiple levels of medical, dental and vision coverage for full-time and part-time employees.
• Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short
• and long-term disability, paid family leave and paid time off.
• Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
• Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
• Professional Development: Ongoing learning and career advancement opportunities.