Credit Specialist

Summary

Optum is a global healthcare organization that uses technology to help people live healthier lives. The Credit Specialist researches and resolves patient and insurance credit balances within the healthcare revenue cycle by reviewing account activity, processing refunds, transfers, and adjustments, and documenting resolutions. The role also collaborates with internal teams to resolve discrepancies and prevent incorrect refunds.

Responsibilities

• Research patient and insurance credit balances by reviewing payment history, adjustments, remittances, correspondence, and supporting documentation
• Identify the cause of a credit, including duplicate or excess payments, payment posting errors, reversals, payer recoupments, or changes in patient or insurance responsibility
• Determine the appropriate resolution of a credit, such as a patient refund, payer refund, transfer, or adjustment, in accordance with established policies and procedures
• Initiate refund transactions in Epic, verifying the amount, recipient, and supporting documentation before submitting them for required review and approval
• Research payer overpayments, including government payer overpayments, and follow applicable refund and documentation workflows
• Review account information for discrepancies or conflicting payer information. Refer issues requiring correction or further validation to the appropriate team before proceeding with a refund
• Process account transfers and adjustments, and document the research, actions taken, and resolution in the billing system
• Respond to internal inquiries regarding credit balances, refunds, and account activity. Coordinate with billing, follow-up, payment posting, Finance, Treasury, and other partners as needed
• Identify and route eligible unclaimed credits through the established escheatment process
• Maintain accurate account notes and supporting records while meeting established productivity, quality, and turnaround expectations
• Identify recurring causes of credit balances and communicate account findings or workflow issues to the supervisor

Skills

• High School Diploma/GED or equivalent work experience
• Must be 18 years of age OR older
• 2+ years of experience in accounts receivable, billing, credit balance resolution, or a related financial transaction role in healthcare field
• Experience with Microsoft Office applications, including Microsoft Excel
• Ability to research transaction history, identify discrepancies, and make sound decisions based on supporting documentation
• Strong attention to detail, organizational skills, and written and verbal communication skills
• Ability to manage a high-volume workload while meeting quality and turnaround expectations
• Experience in healthcare revenue cycle, medical billing, or credit balance resolution
• Experience with payment posting, including reviewing ERAs, EOBs, payments, and adjustments
• Experience researching patient and insurance overpayments and initiating refunds
• Epic experience

Qualifications

Must Haves

• High School Diploma/GED or equivalent work experience
• Must be 18 years of age OR older
• 2+ years of experience in accounts receivable, billing, credit balance resolution, or a related financial transaction role in healthcare field
• Experience with Microsoft Office applications, including Microsoft Excel
• Ability to research transaction history, identify discrepancies, and make sound decisions based on supporting documentation
• Strong attention to detail, organizational skills, and written and verbal communication skills
• Ability to manage a high-volume workload while meeting quality and turnaround expectations

Nice to Haves

• Experience in healthcare revenue cycle, medical billing, or credit balance resolution
• Experience with payment posting, including reviewing ERAs, EOBs, payments, and adjustments
• Experience researching patient and insurance overpayments and initiating refunds
• Epic experience

Benefits

• Remote work in PST and CST.
• Up to 6 weeks of virtual training aligned to your schedule.
• Comprehensive benefits package, subject to eligibility requirements.
• Incentive and recognition programs, subject to eligibility requirements.
• Equity stock purchase, subject to eligibility requirements.
• 401k contribution, subject to eligibility requirements.
• Career development opportunities.