Refund-Payment Processor (51257)

Job Title: Refund Specialist

Job Summary

We are seeking an organized and precise Medical Refund Specialist to review healthcare billing accounts to resolve credit balances. In this role you will investigate billing data, verify insurance contracts, and determine if an overpayment occurred. Once a posting error or overpayment is confirmed, you will process the necessary correction and route the refund request for approval and disbursement.

Key Responsibilities

• Credit Balance Review: Analyze patient accounts and monthly credit reports to identify overpayments made by patients or insurance payers.
• Refund Processing: Validate, prepare, and track refund requests from inception to payout, ensuring accurate documentation is attached.
• Account Reconciliation: Read and interpret Explanation of Benefits (EOBs) to confirm precise payment posting, claim reversals, and payer offsets.
• Compliance & Approvals: Route refund requests to management for approval signature, adhering strictly to internal financial controls and healthcare laws (such as HIPAA).
• Payer & Patient Communication: Interact with insurance carriers, clearinghouses, and patients via telephone or digital portals to research and resolve collection errors.
• Record Keeping: Maintain a detailed chronological ledger of refund logs, account notes, and audits to support organizational readiness for financial reviews.

Required Qualifications

• Education: High School Diploma or equivalent.
• Experience: 1 to 2+ years of experience in medical billing, healthcare insurance collections, or revenue cycle management.
• Technical Skills: High proficiency with Microsoft Office products (specifically Excel for tracking spreadsheets and SharePoint) and experience navigating Electronic Health Record (EHR) or billing systems.
• Core Competencies: Strong mathematical aptitude, sharp attention to data detail, and clear written/verbal communication skills for resolving discrepancies.

Preferred Qualifications

• Comprehensive understanding of payer contracts, government guidelines (Medicare/Medicaid), and commercial insurance workflows.
• Working knowledge of medical terminology, CPT’s, and ICD-10 coding.