Credit Resolution Specialist

Position Summary

The Revenue Cycle Credit Resolution Specialist is responsible for researching and resolving patient and insurance credit balances, processing refunds and transfers, and responding to refund-related inquiries from patients, payers, and internal teams. This role requires strong account research skills, attention to detail, and the ability to determine the appropriate resolution based on account activity, payer requirements, and established Revenue Cycle processes.

Schedule

Full-time Monday - Friday, start and end time are flexible.

Key Duties and Responsibilities

The key duties and responsibilities of the Credit Resolution Specialist include, but are not limited to:

• Research patient and insurance credit balances by reviewing payments, adjustments, claim activity, refunds, account notes, and transaction history.
• Process patient and insurance refunds using the appropriate payment method and Revenue Cycle system while ensuring accuracy and preventing duplicate refunds.
• Review and complete credit transfers, reallocations, overpayment requests, and other assigned credit-resolution work.
• Identify insurance credits requiring refund, claim correction, AR review, untimely credit adjustments, monitoring, or additional research.
• Review assigned reports, work queues, and SharePoint request folders daily and complete requests within established turnaround times.
• Maintain clear account documentation, status updates, and supporting information for completed and pending work.
• Escalate unclear accounts, system issues, or workflow concerns in a timely manner.
• Provide professional and accurate customer service to patients, insurance companies, and internal stakeholders regarding refund and credit-balance inquiries.

Education/Experience

• High school diploma or equivalent required; additional education preferred.
• Previous healthcare revenue cycle, billing, accounts receivable, payment posting, credit balance, refund, or related financial experience preferred.
• Experience working with patient and insurance account activity and healthcare reimbursement is preferred.
• Ability to research account activity, identify the cause of a credit balance, and determine the appropriate resolution.
• Understanding of healthcare billing, payer reimbursement, patient responsibility, adjustments, refunds, and credit balances.

Knowledge, Skills and Abilities

• Strong Excel and Microsoft Office skills.
• (Preferred) Experience with revenue cycle systems such as NextGen, AMKAI,SIS, Waystar, Phreesia, SharePoint, or similar systems preferred.
• Strong written and verbal communication, organization, and customer service skills.
• Ability to manage multiple assignments, meet established deadlines, document work accurately, and escalate concerns appropriately.
• Strong attention to detail with the ability to work independently while following established policies and procedures.

Work Environment/Physical Demands

The work environment/physical demands described here are representative of those that must be met by a teammate to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable differently abled persons to perform the essential functions.