I’m Jen, a former Assistant Manager for Credit Balance at Optum, with 9 years of specialized experience in revenue cycle management (RCM), particularly in resolving credit balances, a critical and often complex aspect of medical billing. My expertise lies in identifying discrepancies, reconciling claims, and ensuring accurate financial outcomes for healthcare organizations.
Key Responsibilities and Achievements in Credit Balance Resolution:- Conducted thorough reviews of insurance paid claims to determine accuracy, underpayments, or denials contributing to credit balances.- Investigating debit balances to identify outstanding patient responsibilities or unposted payments, ensuring timely resolution through billing or payment posting.- Processed refunds for overpayments made by insurance providers or patients, following a detailed review of services rendered and diagnoses.- Verified payer details, including single or multi-payer involvement, and confirmed patient eligibility via insurance portals or direct communication with insurers.- Managed aged claims with unresolved credit balances, performing root-cause analysis and implementing appropriate resolutions.- Monitoring accounts receivable post-refund processing to support Optum’s financial integrity.
Leadership Experience:- Promoted to Subject Matter Expert (SME) in my fifth year, where I oversaw process adherence, maintained and updated the knowledge base manual, and audited claims to ensure compliance and accuracy.- Advanced to Assistant Manager, leading a team of over 20 agents. I was responsible for coaching, mentoring, and ensuring high-quality execution of workflows, while fostering a culture of accountability and continuous improvement.
