We offer competitive pay as well as PTO, Holiday pay, and comprehensive benefits package!

 
Benefits:

· Health insurance

· Dental insurance

· Vision insurance

· Life Insurance

· Pet Insurance

· Health savings account

· Paid sick time

· Paid time off

· Paid holidays

· Profit sharing

· Retirement plan 

GENERAL SUMMARY

The Director, Credit Balance Resolution & Underpayment Detection is responsible for the strategic oversight and operational leadership of the credit balance resolution and underpayment detection functions. This role will manage a team of internal staff and external vendors dedicated to identifying, resolving, and preventing payer and patient credit balances, disputing inappropriate refund requests from payers, monitoring takebacks for validity, and ensuring timely and accurate refund processing. The Director will also be responsible for designing and implementing processes to detect underpayments, develop actionable reporting, and drive process improvements using data and technology. This position plays a critical role in ensuring revenue integrity, regulatory compliance, and optimal cash flow within the organization.

ESSENTIAL JOB FUNCTION/COMPETENCIES

The responsibilities and duties described in this job description are intended to provide a general overview of the position. Duties may vary depending on the specific needs of the affiliate or location you are working at and/or state requirements. Responsibilities include but are not limited to:

• Lead and manage a team responsible for investigating and resolving credit balances on patient and payer accounts.
• Manages federal payer credit balances to ensure compliance with overpayment refunds.
• Oversee the timely review and processing of refund requests, ensuring accuracy and compliance with payer and regulatory requirements.
• Develop and implement policies for disputing invalid refund requests. Monitors and reports takebacks, identifying improper takebacks and escalating with payers to resolve.
• Monitor timeliness of refund issuance and ensure all actions are documented clearly in the billing system.
• Create and maintain standardized workflows for credit balance resolution to ensure consistency, compliance, and operational efficiency.
• Design and implement credit balance reporting, including classification of “unassigned credits,” to prioritize work and predict refund likelihood.
• Collaborate with finance and accounting to reconcile refund activity with payment and cash posting processes.
• Develops, pilots and manages technology to supplement team activities. Monitors results to ensure that technology is efficient and effective application and use of technology to supplement internal and external workforce.
• Build and maintain processes to proactively detect payer underpayments, including setting thresholds and exception reporting.
• Analyze trends and develop root cause analyses to identify systemic payer issues or contract compliance gaps.
• Collaborate with the Contracting and Payer Relations teams to resolve recurring underpayment issues.
• Track and report on underpayment recovery performance, categorizing opportunities by payer, service line, and root cause.
• Lead initiatives to develop and deploy technology solutions and analytics tools, to automate credit balance workflows and underpayment detection.
• Identify and implement process improvements to increase productivity, accuracy, and recovery.
• Partner with IT, billing, and analytics teams to ensure system enhancements support operational needs.
• Manage relationships with outsourced vendors handling credit balance and underpayment work; monitor performance and ensure adherence to SLAs and quality standards.
• Establish performance metrics and KPIs for internal and external resources.
• Provide leadership, training, and coaching to team members; foster a culture of accountability, excellence, and continuous improvement.
• Performs other position related duties as assigned.
• Employees shall adhere to high standards of ethical conduct and will comply with and assist in complying with all applicable laws and regulations. This will include and not be limited to following the Solaris Health Code of Conduct and all Solaris Health and Affiliated Practice policies and procedures; maintaining the confidentiality of patients' protected health information in compliance with the Health Insurance Portability and Accountability Act (HIPAA); immediately reporting any suspected concerns and/or violations to a supervisor and/or the Compliance Department; and the timely completion the Annual Compliance Training.

CERTIFICATIONS, LICENSURES OR REGISTRY REQUIREMENTS

• N/A

KNOWLEDGE | SKILLS | ABILITIES

• Deep understanding of payer refund processes, HIPAA regulations, and federal/state refund requirements.
• Strong analytical and reporting skills, with the ability to derive insights from large datasets.
• Proven ability to lead teams, manage change, and deliver measurable results.
• Excellent verbal and written communication skills.
• Strong project management, prioritization, and organizational skills.
• Ability to ensure accurate and timely processing of refunds in alignment with organizational and compliance standards.
• Proven skill in resolving credit balances and recovering underpayments efficiently and at scale.
• Ability to analyze and reduce unassigned or unclassified credits through effective account research and resolution strategies.
• Experience in monitoring and evaluating vendor performance using key metrics such as turnaround time (TAT) and quality benchmarks.
• Strong understanding of underpayment recovery processes, with the ability to meet or exceed recovery rate targets.
• Ability to meet productivity expectations while maintaining high standards of quality and accuracy in all assigned tasks.

EDUCATION REQUIREMENTS

• Bachelor’s degree in Healthcare Administration, Finance, Accounting, or a related field required; Master’s degree preferred.

EXPERIENCE REQUIREMENTS

• Minimum of 7–10 years of progressive experience in healthcare revenue cycle operations, with at least 3 years in a leadership role overseeing credit balance resolution and/or underpayment recovery.
• Experience working with large EMRs/practice management systems and healthcare financial systems.
• Experience managing vendor partnerships and technology-driven process improvements.

REQUIRED TRAVEL

• N/A

PHYSICAL DEMANDS

Carrying Weight Frequency

1-25 lbs. Frequent from 34% to 66%

26-50 lbs. Occasionally from 2% to 33%

Pushing/Pulling Frequency

1-25 lbs. Seldom, up to 2%

100 + lbs. Seldom, up to 2%

Lifting - Height, Weight Frequency

Floor to Chest, 1 -25 lbs. Occasional: from 2% to 33%

Floor to Chest, 26-50 lbs. Seldom: up to 2%

Floor to Waist, 1-25 lbs. Occasional: from 2% to 33%

Floor to Waist, 26-50 lbs. Seldom: up to 2%