Credit Balance Analyst

Job Summary

Key Responsibilities

• Review patient accounts to identify credit balances resulting from overpayments, duplicate payments, contractual adjustments, or billing errors
  
• Research Explanation of Benefits (EOBs), remittance advice, payment postings, and charge details to determine root causes
  
• Process refunds to patients or insurance payers in accordance with payer contracts and compliance guidelines
  
• Coordinate with billing, coding, cash posting, AR follow-up, and compliance teams to resolve discrepancies
  
• Ensure adherence to CMS regulations, payer-specific refund timelines, and HIPAA requirements
  
• Maintain accurate documentation of all research, actions, and resolutions in billing systems
  
• Prepare and track credit balance reports and productivity metrics
  
• Support internal and external audits related to credit balances and refunds
  
• Identify trends and recommend process improvements to prevent recurring credit balances
  

Required Skills & Qualifications

• 13 years of experience in US healthcare revenue cycle, billing, or accounts receivable
  
• Strong understanding of EOBs, CPT/HCPCS codes, ICD-10, and payer adjudication
  
• Knowledge of Medicare, Medicaid, and commercial insurance guidelines
  
• High attention to detail with strong analytical and problem-solving skills
  
• Proficiency in healthcare billing systems and Microsoft Excel
  
• Ability to handle PHI in compliance with HIPAA standards

Preferred Qualifications

• Experience working with hospital or physician billing (professional or facility claims)
  
• Familiarity with refund regulations and payer audit requirements
  
• Prior experience in offshore/onshore healthcare RCM operations

Work Environment

• Revenue Cycle / Healthcare Operations setting
  
• May involve offshore support for US healthcare clients
  
• Requires handling confidential patient and financial data