Credit Management Representative

1 day ago

Pasig, Philippines Med-Metrix, LLC 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 appropriate 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 payer-related special projects involving erroneous refunds and retractions.
  7. Review payer refund request letters and respond promptly to resolve issues.
  8. Maintain work queues to ensure timely account processing.
  9. Identify trends and escalate to supervisors as needed.
  10. Follow client-specific workflows and tasks.
  11. Collaborate effectively with co-source partners and other teams supporting the business.
  12. Retrieve EOBs to post payments and denials.
  13. Utilize the MCX workflow system, client systems, payer websites, and other tools.
  14. Participate in special projects, utilizing Excel spreadsheets and communicating results.
  15. Meet daily productivity standards as per departmental policies.
  16. Adhere to policies and procedures for the client and team.
  17. Maintain confidentiality at all times.
  18. Maintain a professional attitude.
  19. Perform other duties as assigned by management.
  20. Comply with Information Security and HIPAA policies and procedures, safeguarding patient PHI.
Qualifications
  • High School diploma or equivalent.
  • 1 year of experience in insurance collections, credit balance management, or payment posting.
  • 1-3 years of experience in physician/professional billing.
  • Working knowledge of the insurance follow-up process and healthcare reimbursement methodologies.
  • Understanding of EOBs, remarks, and denials.
  • Basic knowledge of healthcare claims processing, including ICD-10, CPT, and HCPCS codes.
  • Ability to work independently and in a team.
  • Proficiency with Microsoft Office.
  • Strong communication skills, both oral and written.
  • Strong organizational skills.
Working Conditions
  • Work Set-Up: Onsite
  • Work Schedule: Mid or night shift
  • Physical Demands: Occasional movement around the work area, sitting, manual tasks, operating office equipment, extending arms, kneeling, talking, and hearing.
  • Mental Demands: Ability to follow directions, collaborate, and handle stress.
  • Work Environment: Usually minimal noise level.

Med-Metrix is committed to equal employment opportunity and does not discriminate based on race, color, religion, sex, parental status, national origin, age, disability, genetic information, political affiliation, military service, veteran status, or other protected characteristics.

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