Credit Specialist

Summary

UnitedHealth Group, through its Optum organization, delivers technology-enabled healthcare services and resources. The Credit Specialist researches and resolves patient and insurance credit balances, determines appropriate resolutions, processes refunds, transfers, and adjustments, and coordinates with internal teams to ensure accurate documentation and compliance with established workflows.

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 with flexibility to work remotely in the Pacific and Central Time Zones
• Up to 6 weeks of virtual training aligned to your schedule
• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution
• Career development opportunities