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Credit Balance Specialist analyzes all credit balances before a refund or adjudication is considered and/or processed. The Credit Balance Specialist performs duties while remaining compliant with all CMS guidelines. This position requires detailed analysis and critical thinking to determine what is necessary to correct an account. This position requires extensive insurance knowledge and coordination of benefits within the healthcare setting. Customer service, organizational, and communication skills are essential to this position. This position requires prioritizing multiple tasks simultaneously in an occasionally stressful environment. This position also requires strong computer skills, typing & ten-key skills, and a working knowledge of HIPAA guidelines. 

Eyecare Services Partners selects best-in-class Ophthalmic and Optometric practices that are focused on essential eye health issues. Our practice groups excel in the utilization of advanced technology and processes to provide safe and optimal outcomes for our practices. ESP and our associated practices represent a community of dedicated leaders, compassionate providers and surgeons, plus highly skilled clinical teams supporting communities and their eye care needs.

• Maintain a daily view of credit refund work queues.
• Review posting errors and make the necessary corrections
• Determine the most efficient process to resolve refund requests or credit balance
• Work with payor throughout the resolution process
• Maintain knowledge of insurance processes
• Utilizes all available resources (EOBs, Waystar, Change, payor websites, Availity, etc.) to ensure refunds/take-backs (recoupments) are adjudicated correctly.
• Notify payor of initiated take-backs and submit to management for prior approval.
• Updates NextGen to ensure proper documentation for refunds
• Answer questions from billing managers regarding the posting of payments; work closely with billing managers to resolve any issues

• Three years of professional medical billing and collecting experience; or certification obtained from a nationally accredited billing program, i.e., CMBS (Certified Medical Billing Specialist).
• Two years of payment rep/cash posting experience in Optometry and Ophthalmology.
• Knowledge of payer contracts and (EOBs), explanation of benefits Experience working in a clearinghouse.
• Experience with Excel and Windows-based programs.
• Experience performing tasks that require a basic understanding of accounting and math skills.

Preferred Experience

• + Experience NextGen PM/EHR
• + Two years of Optometry and Ophthalmology third-party billing guidelines and expertise.

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