Role and Responsibilities: 

The Hospital Refund Specialist has the responsibility of identifying and resolving credit balances on patient accounts to ensure refunds are issued in a timely manner. This position ensures the highest quality and safe delivery of customer service, maintain compliance with professionalism and regulatory processes. Interface with facility clients and internal corporate stakeholders.

• Manage daily work queues of credit balances for both onshore & offshore teams.
• Research, initiate follow-up and resolve all health care insurance claim accounts with existing credit balances.
• Complete thorough review of patients’ accounts with credit balances to validate the patient overpayment is accurate.
• Recommend an adjustment when applicable or recommend a refund of the overpayments to the insurance carrier or patient, providing the appropriate documentation.
• Apply knowledge related to insurance contracts, interpret explanation of benefits, understand regulations concerning coordination of benefits and other applicable guidelines.
• Process refunds accurately and in timely manner adhering to contract language where appropriate.
• Navigate through various payer systems and multiple internal systems to ensure timely and accurate resolution of claims.
• Use critical and analytical problem-solving skills to resolve issues
• Uses strong organizational skills to effectively manage large amounts of detailed information
• Utilizes excellent written and oral communication skills to collaborate and maintain positive working relationships with peers, leaders, surgery centers, and payer representatives to resolve credit balances.
• Consistent, regular, punctual attendance as scheduled is an essential responsibility of this position
• Other duties as assigned

Qualifications and Education Requirements: 

• High school graduate or equivalent.
• Must have the skills necessary to operate the office equipment required to fulfill job duties
• Excel, Word, Outlook
• Able to navigate through nThrive and Availity (preferred)
• Previous credit balance resolution experience in a facility or CBO environment
• 2 years combined experience CBO in Billing, Cash Collections, Denials, Disputes, Follow-up, and/or appeals
• Understanding of medical terminology
• Basic understanding of credit and refund guidelines
• Additional Notes

This is not an all-inclusive list. Additional tasks and responsibilities may be added by management based on business need.