Credit Balance Specialist

<p><b>About Our Company:</b><br>At Infinx, we're a fast-growing company focused on delivering innovative technology solutions to meet our clients' needs. We partner with healthcare providers to leverage automation and intelligence, overcoming revenue cycle challenges and improving reimbursements for patient care. Our clients include physician groups, hospitals, pharmacies, and dental groups.<br>We're looking for experienced associates and partners with expertise in areas that align with our clients' needs. We value individuals who are passionate about helping others, solving challenges, and improving patient care while maximizing revenue. Diversity and inclusivity are central to our values, fostering a workplace where everyone feels valued and heard.</p><p><strong>A 2025 Great Place to Work</strong><i><strong>®</strong></i></p><p>In 2025, Infinx was certified as a Great Place to Work<i>®</i> in both the U.S. and India, underscoring our commitment to fostering a high-trust, high-performance workplace culture. This marks the fourth consecutive year that Infinx India has achieved certification and the first time the company has earned recognition in the U.S.<br><br><strong>Location: </strong>Remote</p><strong>Summary Description:</strong><br>The Credit Balance Resolution Specialist resolves complex credit balance accounts across hospital and physician portfolios while preventing inappropriate refunds. This role requires deep command of coordination of benefits, contractual reimbursement, unapplied payments, and payer takeback rules to ensure accurate resolution in multi-payer scenarios.<br>This role is in a high-volume, metrics-oriented outsourced environment with client-specific productivity and quality targets. The Credit Balance Specialist makes independent, defensible decisions on challenging cases and coordinates with payment posting, AR follow-up, and patient financial services to resolve credit balances at the root.<br><strong>Job Responsibilities:</strong>  <ul><li>Analyze patient accounts with credit balances, validating overpayment accuracy by evaluating EOBs, remittance advices, payment history, COB sequencing, and expected reimbursement before processing any refund</li><li>Identify root causes of credit balances including posting errors, duplicate payments, COB failures, contract variances, unapplied cash, and incorrect adjustments</li><li>Validate refund requests and takeback notifications from third-party payers against contracts, payment history, and claim adjudication to prevent inappropriate refunds</li><li>Research and resolve unapplied payments by reconciling remittance advices, deposits, and account histories to allocate funds to the correct accounts</li><li>Investigate complex multi-payer scenarios involving Medicare/Medicaid crossovers, third-party liability, workers' compensation, motor vehicle accident, and secondary/tertiary billing</li><li>Make independent, defensible decisions on challenging cases requiring interpretation of payer contracts, billing regulations, and revenue cycle policy</li><li>Coordinate with payment posting, AR follow-up, contract management, and patient financial services to resolve account issues at the root</li><li>Process patient and payer refunds accurately and timely in accordance with state escheatment laws and federal overpayment rules</li><li>Communicate professionally with insurance companies, patients, and internal departments regarding credit balance inquiries</li><li>Document all account activity and resolution steps with clear, concise, and actionable notes</li><li>Maintain productivity and quality standards in a high-volume, deadline-driven environment</li><li>Maintain full compliance with HIPAA, billing compliance, CMS regulations, and fraud/abuse regulations</li><li>Assignments may shift across client portfolios and credit balance categories based on volume and priority within the scope of the role</li></ul><strong>Skills and Education:   </strong> <ul><li>High School Diploma or GED</li><li>4-7 years of hospital and/or physician accounts receivable experience with hands-on credit balance resolution responsibilities</li><li>Experience with both facility (UB-04) and professional (CMS-1500) credit balance resolution preferred</li><li>Background in payment posting, denials management, or revenue integrity preferred</li><li>CRCR (Certified Revenue Cycle Representative) or equivalent certification preferred</li><li>Proven track record resolving complex credit balance issues and payment discrepancies</li><li>Comprehensive knowledge of revenue cycle workflows, coordination of benefits, and primary/secondary/tertiary payer determination</li><li>Working knowledge of managed care contracts and reimbursement methodologies and claim adjudication processes</li><li>Strong analytical skills to interpret EOBs, remittances, contracts, and payment documentation</li><li>Familiarity with state escheatment/unclaimed property laws and the CMS 60-day overpayment rule</li><li>Proficiency navigating hospital or physician EHR, PMS, and billing systems</li><li>Familiarity with ERA/EFT processing, clearinghouses, and payer portals preferred</li><li>Advanced Excel proficiency (pivot tables, VLOOKUP, formulas, data analysis)</li><li>Ability to establish and maintain effective working relationships with team members, supervisors, managers, clients, and providers</li><li>Ability to prioritize workload and manage multiple responsibilities in a highly organized, efficient, and effective manner</li><li>Knowledge of HIPAA, billing compliance, CMS regulations, and fraud/abuse regulations</li></ul><strong>Company Benefits and Perks:</strong><br>Joining Infinx comes with an array of benefits, flexible work hours when possible, and a genuine sense of belonging to a dynamic and growing organization.<ul><li>Access to a 401(k) Retirement Savings Plan.</li><li>Comprehensive Medical, Dental, and Vision Coverage.</li><li>Paid Time Off.</li><li>Paid Holidays.</li><li>Additional benefits, including Pet Care Coverage, Employee Assistance Program (EAP), and discounted services.</li></ul>If you are a dedicated and experienced Credit Balance Specialist ready to contribute to our mission and be part of our diverse and inclusive community, we invite you to apply and join our team at Infinx.