Credit Balance Specialist - Healthcare Hospital Claims

Job Family :

Patient Account Representative, PFS Billing, PFS General

Travel Required :

None

Clearance Required :

None

What You Will Do:

The  Credit Balance Specialist  (Hospital Claims) will manage credit balance workloads of patients and respond/follow-up on external and internal inquires in a timely manner. This person should have a solid understanding of the Revenue Cycle as it relates to the entire life of a patient account from creation to payment.

Individuals must be able to work an eight hour shift between the hours of 8:30 AM CT - 5:30 PM CT, with no remote work initially BUT an opportunity for some hybrid (in office/remote) schedules after training.Â

We will consider individuals open to relocation to San Antonio!Â

Additionally, the Credit Balance Specialist will:

• Research and resolve patient credit balance accounts resulting from overpayments, duplicate payments, financial assistance adjustments, or insurance reprocessing.

• Analyze overpayments, duplicate payments, coordination of benefits (COB), retro eligibility, and contractual adjustment discrepancies.

• Collaborate with billing, cash posting, denial management, and patient access teams to resolve account discrepancies.

• Process patient refunds accurately and timely in accordance with client policies and regulatory requirements.

• Communicate with patients regarding refund status, account balances, and payment discrepancies professionally and compassionately.

• Maintain accurate, clear, concise and complete account notes and other relevant information.

• Resolve unidentified payments through research.

• Aim to have patient accounts balance to zero prior to accounts being forwarded to an outside agency for collections.

• Assist with internal and external audits related to credit balance processes and refund activity.

What You Will Need :

• High School Diploma / GED.

• 1+ years of working with credit balance accounts (refund, overpayment, underpayment, accounts resolution, etc.)

• Working knowledge of the following: health insurance claims, medical billing, medical coding, credit finance, accounting or customer service-related responsibilities

What Would Be Nice To Have :

• Credit balance experience within a hospital background

• Experience working within Epic, Meditech or other hospital patient accounting systems.

• Ability to interpret UB-04 claims, payer correspondence, and contractual agreements.

• Basic knowledge of Commercial, Managed Care, Medicare and Medicaid insurance

• PC skills in a Windows environment.

• Knowledge and utilization of desktop applications to include Word and Excel.

• Ability to initiate and follow through on projects and work independently with minimal supervision.

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What We Offer :

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

• Medical, Rx, Dental & Vision Insurance

• Personal and Family Sick Time & Company Paid Holidays

• Position may be eligible for a discretionary variable incentive bonus

• Parental Leave

• 401(k) Retirement Plan

• Basic Life & Supplemental Life

• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts

• Short-Term & Long-Term Disability

• Tuition Reimbursement, Personal Development & Learning Opportunities

• Skills Development & Certifications

• Employee Referral Program

• Corporate Sponsored Events & Community Outreach

• Emergency Back-Up Childcare Program

About Guidehouse

Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at View phone number on click.appcast.io or via email at View email address on click.appcast.io . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or View email address on click.appcast.io . Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.

If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse’s Ethics Hotline. If you want to check the validity of correspondence you have received, please contact View email address on click.appcast.io . Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized third parties.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.