Credit Management Representative

2 days ago

Pasig, National Capital Region, Philippines Med-Metrix Full time
Job Description

Posted Monday, May 5, 2025 at 4:00 PM

Job Purpose

The Credit Management Representative is responsible for all elements of Credit Balance Management, including but not limited to: triaging patient and insurance credit balances to determine root causes, correcting contractual/manual adjustments, identifying overpayments, and creating refund requests with proper documentation to support refunds. The role also involves identifying posting/payer trends and communicating findings to management for resolution.

Duties and Responsibilities

  1. Perform credit balance management for multiple clients.
  2. Review daily credit balance work lists to initiate research of credit balance accounts.
  3. Research, identify root causes, and resolve patient accounts, including posting errors, insurance overpayments, patient overpayments, and system issues.
  4. Prepare and submit refund requests with all necessary backup data, such as EOBs, insurance correspondence, refund explanations, and reimbursement details from the practice management system.
  5. Correct misapplied contractual adjustments.
  6. Prepare spreadsheets for payers regarding special projects involving erroneous refunds and retractions.
  7. Review payer refund request letters and respond appropriately and promptly.
  8. Maintain work queues to ensure timely account processing.
  9. Identify trends and escalate issues to supervisors.
  10. Adhere to client-specific workflows and tasks.
  11. Collaborate effectively with co-source partners and other teams.
  12. Retrieve EOBs to post payments and denials.
  13. Utilize workflow systems, client systems, payer websites, and other tools.
  14. Assist with special projects using Excel spreadsheets and communicate results.
  15. Meet daily productivity standards as per departmental policies.
  16. Follow policies and procedures for the client and team.
  17. Maintain confidentiality and a professional attitude.
  18. Perform other duties as assigned.
  19. Comply with Information Security and HIPAA policies, protecting patient information appropriately.

Qualifications

  1. High School diploma or equivalent.
  2. 1 year of experience in insurance collections, credit balance management, or payment posting.
  3. 1-3 years of experience in physician/professional billing.
  4. Knowledge of the insurance follow-up process and healthcare reimbursement methodologies.
  5. Understanding of EOBs and denials.
  6. Basic knowledge of healthcare claims processing, including ICD-10, CPT, and HCPCS codes.
  7. Ability to work independently and in a team.
  8. Proficiency with Microsoft Office.
  9. Strong communication skills, both oral and written.
  10. Strong organizational skills.

Working Conditions

  1. Work Setup: Onsite.
  2. Work Schedule: Mid or night shift.
  3. Physical Demands: Occasional movement, sitting, manual tasks, operating office equipment, extending arms, kneeling, talking, and hearing.
  4. Mental Demands: Following directions, collaboration, handling stress.
  5. Work Environment: Usually minimal noise level.

Med-Metrix is an equal opportunity employer and does not discriminate based on race, color, religion, sex, national origin, age, disability, or other protected characteristics.

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