Refund Specialist I

Refund Specialist I

The Refund Specialist I is responsible for thoroughly researching patient accounts to identify and resolve overpayments, ensuring accurate refund processing or correction of posting discrepancies within the Athena Billing System. This role requires detailed investigation of unapplied payments, coordination with internal systems, and effective communication with patients, payors, and team members to maintain financial accuracy and compliance.

Location: Remote

Essential Job Functions:

• Investigate all requested refunds and credit balances by reviewing patient accounts for unapplied payments causing overpayments.
• Verify payment application details on patient accounts to confirm accuracy.
• Analyze internal deposit and payment batches to trace deposit origins and detect duplicate postings.
• Utilize Cedar Patient Portal to confirm relevant payment information and initiate refunds when applicable.
• Correct posting discrepancies in the Athena Billing System promptly and accurately.
• Enter cases and document all necessary corrections within the Athena system.
• Perform adjustments within guarantor accounts and process refunds as required.
• Ensure claims are adjudicated correctly by understanding payer-side claim processes in Athena.
• Maintain comprehensive notations in the system to facilitate clear communication and tracking of account activities.
• Initiate refunds through Cedar Patient Portal or directly via Athena Billing System when portal processing is unavailable.
• Execute complete refund check processes including reissue, void, and returned checks following established protocols.
• Maintain organized backup documentation for all adjusted and refunded accounts to support audit readiness.
• Communicate professionally and courteously with coworkers, management, third-party payors, and patients.
• Assist with additional departmental duties as assigned to support overall team objectives.

Knowledge, Skills and Abilities:

• In-depth knowledge of payment processing functions, medical insurance, government payors, and related terminology.
• Proficiency in using personal computers within a Windows environment, including spreadsheet applications and data entry tools.
• Strong attention to detail with excellent problem-solving skills to identify and resolve discrepancies efficiently.
• Effective verbal and written communication skills, maintaining professionalism and confidentiality at all times.
• Ability to organize workload effectively, manage multiple tasks simultaneously, and adapt to changing priorities.
• Willingness and ability to work overtime as needed to meet business demands.

Education and Experience:

• High school diploma or equivalent required.
• Minimum of two years combined experience in medical insurance, payment processing, or insurance follow-up preferred.
• Experience with Insurance Websites/Portals/Overpayment Forms required.
• Strong knowledge of Coordination of Benefits including Government and Commercial Carriers required.
• Proficient in review of Explanation of Benefits and Posting required.
• Strong knowledge in Payer initiated recoupments required.
• Experience with AthenaOne Billing System is preferred but not mandatory.

Physical Demands:

• Regularly required to sit for extended periods; occasional walking, standing, bending, stooping, and lifting up to 15 pounds.
• Must have close visual acuity to perform job duties accurately.

Hourly Rate: $16.33-$30.21

USACS offers a comprehensive and competitive benefits package designed to support the health, well-being, and financial security of our employees.

Benefits may vary based on role, location, and employment status, but generally include:

• Medical, dental, and vision insurance options
• Health savings accounts (HSA) and flexible spending accounts (FSA)
• 401(k) employee and employer contributions
• Paid time off, including vacation, sick leave, and company holidays
• Paid parental leave & family support benefits
• Short-term and long-term disability insurance
• Life and accidental death & dismemberment (AD&D) insurance
• Employee assistance programs & wellness resources

Additional compensation may include bonus eligibility, equity, or other incentive programs, depending on the role.

Specific benefit offerings and eligibility will be provided during the hiring process and may be subject to change in accordance with applicable laws and company policies.