Remote
Description
OUR COMPANY: Revco Solutions Inc provides best-in-class Revenue Cycle management to Hospital and Physician Service clients.
POSITION DESCRIPTION: This role is responsible for the daily review, research, and resolution of credit balance accounts for both hospital (facility) and physician (professional) billing. This role focuses exclusively on resolving existing credit balances through refunds, reallocations, and adjustments in compliance with payer contracts, regulatory requirements, and organizational policies.
MAJOR AREAS OF RESPONSIBILITIES
- Work assigned credit balance inventory queues daily for hospital and physician accounts, prioritizing accounts based on ageing, dollar amount, payer requirements, and regulatory timelines.
- Research the root cause of credit balances, including duplicate payments, overpayments, coordination of benefits errors, retroactive adjustments, contractual discrepancies, and posting inaccuracies.
- Determine the appropriate resolution method for each credit balance, including:
- Refunds to payers or patients
- Reallocation of payments to open balances
- Contractual or administrative adjustments, when applicable
- Prepare and submit refund requests with complete and accurate supporting documentation.
- Review remittance advice (ERAs/EOBs) and account transaction history to validate overpayment sources and resolution accuracy.
- Apply credits to the oldest dates of service first, unless otherwise required by payer or regulatory guidelines.
- Maintain clear, detailed account notes documenting research performed, actions taken, and final resolution.
- Monitor payer and regulatory timelines to ensure timely resolution and avoid compliance risk.
- Escalate complex, high-dollar, or non-standard credit balance scenarios in accordance with established workflows.
- Partners with payment posting, insurance follow-up, billing, coding, and refund teams to resolve credit balances requiring cross-functional action.
- Identify and report recurring credit balance drivers, payer trends, or system issues to leadership.
- Support audit requests and quality reviews by providing account documentation and resolution details.
- Participate in process improvement initiatives to reduce future credit balance volume.
- Meet or exceed established productivity standards for credit balance accounts resolved.
- Maintain high accuracy and compliance with payer contracts, refund policies, and regulatory requirements.
- Ensure timely resolution of credit balances in accordance with organizational and payer timelines.
- Adhere to documentation, audit, and compliance standards.
HOURS: Monday-Friday 8:00am-5:00pm EST
What We Offer:
- Insurance/401k match
- PTO/Paid holidays
- Referral bonuses
Requirements
QUALIFICIATIONS:
- High school diploma or equivalent required.
- 3+ years of healthcare revenue cycle experience focused on credit balance resolution.
- Strong attention to detail and ability to work effectively in a fast-paced environment.
- Strong understanding of billing and collections processes.
- Strong understanding of ERAs/EOBs, payer contracts, and overpayment resolution workflows.
- Proficiency with patient accounting and practice management systems.
- Ability to manage high-volume credit balance inventory independently. Disciplined work ethic with ability to work remotely with little direct supervision and meet production targets.
- Analytical and detail-oriented
- Strong prioritization and time management
- Clear written documentation
- Compliance-focused decision-making
- Collaborative problem-solving
Preferred Qualifications
- Experience with commercial, Medicare, and Medicaid payers.
- Familiarity with refund processing, recoupments, and audit standards.
- Experience working in a centralized business office or large health system.
- Experience with Epic.
Salary Description
$19-23/hr.
