Credit Resolution Specialist (Overpayment) - Dialysis Billing

Overpayment Specialist / Credit Resolution Specialist - Dialysis Billing

Overview:

The Overpayment Specialist / Claims Resolution Specialist is assigned a group of credit balances and is responsible for accurately and efficiently resolving the open claims. Additionally, this individual will review EOB's, contracts, and/or other supporting documentation to determine if payments need to be refunded or if balances can be adjusted in accordance with policies and procedures, including federal, state, and local standards, guidelines, and regulations.

This is a full-time, remote position. Business hours are Monday through Friday, 7:00 AM to 6:00 PM EST. Occasional overtime (including weekends) is required when there is a high volume of tasks and projects.

Essential Functions:

• Manage and resolve credit balances across self-pay, commercial, federal, and state insurance plans, ensuring compliance with company policies and procedures.
• Process refunds through appropriate portals, including live check refunds, and void payments in insurance portals as required.
• Review and interpret Explanation of Benefits (EOBs), remittances, and contracts to identify, submit, and resolve credit adjustments accurately.
• Communicate effectively with patients, insurance companies, collection agencies, and internal teams to address payment discrepancies and manage refund requests.
• Track and document all credit resolution activities within the billing system while meeting the 30-day credit review expectations.
• Complete and maintain detailed facility reports, monitor returned or voided checks, and ensure timely follow-up on outstanding items.
• Stay updated on payer guidelines, insurance policies, fee schedules, and contract language to ensure accurate billing and claims resolution.
• Maintain compliance with HIPAA regulations and uphold strict confidentiality of patient information at all times.
• Collaborate with team members, provide support when needed, and demonstrate adaptability to learn new processes in a fast-paced environment.
• Perform additional tasks and special projects as assigned by the Supervisor or Manager.

Required Education and Experience:

• Bachelor's degree in business, healthcare management, or related field is preferred (equivalent experience considered).
• 0-2 years of experience in accounts receivable, medical insurance billing and reimbursement, claims management, or insurance appeals.
• Experience in dialysis billing and medical claim credit balance resolution is preferred.
• Excellent communication and customer service skills for interacting with insurance companies, patients, and all levels of management.
• Strong attention to detail to identify and address discrepancies accurately.
• Proficiency in Microsoft Office Suite, with advanced Excel skills (e.g., PivotTables, VLOOKUP) is required.
• Familiarity with fee schedules, payer contracts, and insurance overpayment/credit resolution policies and procedures is preferred.
• Experience researching and navigating payer websites and portals is preferred.

About Innovative Renal Care
At Innovative Renal Care (IRC), we are one of the largest dialysis service providers in the U.S., partnering with local physicians to deliver high-quality care to patients with ESRD and other kidney conditions. Our mission is to be the trusted experts and preferred partners for patients, physicians, and healthcare providers by delivering best-in-class care, service, and solutions.

Our values, summarized as I CARE, guide everything we do:

• Integrity & Innovation: Earn trust by delivering on promises and finding new ways to solve problems.
• Compassion: Treat patients, their families, and colleagues with respect and empathy.
• Accountability: Take responsibility and show appreciation for others.
• Results Driven: Strive to exceed expectations and achieve excellence.
• Everyone Counts: Foster diversity, equity, teamwork, and collaboration.

Equal Opportunity Employer:

Innovative Renal Care is an equal opportunity employer and a drug free workplace. All qualified We applicants will receive consideration for employment without regards to race, color, religion, sex, sexual orientation, gender identity, national origin, citizenship, disability, or protected veteran status.

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