Revenue Cycle Refund Specialist

Refund Specialist

Under the direction of the Revenue Cycle Director, the RCM Refund Specialist is responsible for reviewing, processing, and reconciling patient and payer refunds. This role ensures accuracy, compliance with payer regulations, and timely resolution of credit balances within the billing system. (This is a full time position that will support our RCM team at SouthPark Monday to Friday, 8 am to 5 pm) Primary job responsibilities may include, but are not limited to:

• Reviews patient accounts to identify credit balances and determines appropriate refund action.
• Processes refunds to patients and third-party payers in accordance with organizational policies and regulatory requirements.
• Performs detailed account analysis to ensure accuracy of balances prior to refund issuance.
• Investigate and resolve refund discrepancies, including overpayments, duplicate payments, and incorrect postings.
• Ensures compliance with federal and state regulations, payer guidelines, and internal policies related to refunds.
• Maintains accurate documentation of all refund transactions and supporting records.
• Communicates with payers, patients, and internal departments regarding refund status and inquiries.
• Collaborates with billing, coding, and payment posting teams to resolve account issues contributing to credit balances.
• Monitors refund queues and worklists to ensure timely processing within established turnaround times.
• Identifies trends and root causes of credit balances and recommends process improvements.
• Assists with audits and reporting related to refunds and credit balances.
• Meets and exceeds short- and long-term departmental goals.
• Performs duties in accordance with departmental policies and procedures.
• Recommends new approaches, policies, and procedures to improve efficiency and accuracy.
• Takes ownership of special projects and follows through with detailed action plans.
• Actively participates in problem identification and resolution.
• Performs other related duties as required and assigned.

Requirements:

• High school diploma or GED completion is required.
• Associate degree in Healthcare Administration, Business, or related field preferred.
• A minimum of two years' experience working patient and third-party refunds are required.
• Good working knowledge of medical terminology and anatomy required.

Experience:

• Minimum of 2 years of experience in healthcare revenue cycle, preferably in refunds, accounts receivable, or payment posting.
• Knowledge of third-party payer.
• Experience with billing systems and electronic health records (EHR).
• Guidelines, overpayment regulations, and refund processes.
• Strong analytical and problem-solving skills.
• Attention to detail with ability to manage high-volume workload.
• Strong interpersonal and communication skills.
• Ability to work independently in a fast-paced environment.
• Physical Requirements:
• Work consistently requires walking, standing, sitting, lifting, reaching, stooping, bending, pushing, and pulling.
• Must be able to lift and support weight of 35 pounds.
• Ability to concentrate on detailed tasks for extended periods.
• Prolonged computer use required.