Credit Balance Specialist

About Our Company: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.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.A 2025 Great Place to Work®In 2025, Infinx was certified as a Great Place to Work® 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.Location: RemoteSummary Description: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.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.Job Responsibilities:  Analyze patient accounts with credit balances, validating overpayment accuracy by evaluating EOBs, remittance advices, payment history, COB sequencing, and expected reimbursement before processing any refundIdentify root causes of credit balances including posting errors, duplicate payments, COB failures, contract variances, unapplied cash, and incorrect adjustmentsValidate refund requests and takeback notifications from third-party payers against contracts, payment history, and claim adjudication to prevent inappropriate refundsResearch and resolve unapplied payments by reconciling remittance advices, deposits, and account histories to allocate funds to the correct accountsInvestigate complex multi-payer scenarios involving Medicare/Medicaid crossovers, third-party liability, workers' compensation, motor vehicle accident, and secondary/tertiary billingMake independent, defensible decisions on challenging cases requiring interpretation of payer contracts, billing regulations, and revenue cycle policyCoordinate with payment posting, AR follow-up, contract management, and patient financial services to resolve account issues at the rootProcess patient and payer refunds accurately and timely in accordance with state escheatment laws and federal overpayment rulesCommunicate professionally with insurance companies, patients, and internal departments regarding credit balance inquiriesDocument all account activity and resolution steps with clear, concise, and actionable notesMaintain productivity and quality standards in a high-volume, deadline-driven environmentMaintain full compliance with HIPAA, billing compliance, CMS regulations, and fraud/abuse regulationsAssignments may shift across client portfolios and credit balance categories based on volume and priority within the scope of the roleSkills and Education:    High School Diploma or GED4-7 years of hospital and/or physician accounts receivable experience with hands-on credit balance resolution responsibilitiesExperience with both facility (UB-04) and professional (CMS-1500) credit balance resolution preferredBackground in payment posting, denials management, or revenue integrity preferredCRCR (Certified Revenue Cycle Representative) or equivalent certification preferredProven track record resolving complex credit balance issues and payment discrepanciesComprehensive knowledge of revenue cycle workflows, coordination of benefits, and primary/secondary/tertiary payer determinationWorking knowledge of managed care contracts and reimbursement methodologies and claim adjudication processesStrong analytical skills to interpret EOBs, remittances, contracts, and payment documentationFamiliarity with state escheatment/unclaimed property laws and the CMS 60-day overpayment ruleProficiency navigating hospital or physician EHR, PMS, and billing systemsFamiliarity with ERA/EFT processing, clearinghouses, and payer portals preferredAdvanced Excel proficiency (pivot tables, VLOOKUP, formulas, data analysis)Ability to establish and maintain effective working relationships with team members, supervisors, managers, clients, and providersAbility to prioritize workload and manage multiple responsibilities in a highly organized, efficient, and effective mannerKnowledge of HIPAA, billing compliance, CMS regulations, and fraud/abuse regulationsCompany Benefits and Perks: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.Access to a 401(k) Retirement Savings PlanComprehensive Medical, Dental, and Vision CoveragePaid Time OffPaid HolidaysAdditional benefits, including Pet Care Coverage, Employee Assistance Program (EAP), and discounted servicesIf 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.