Job Purpose:

The Refunds Specialist analyzes data to determine whether or not a refund is warranted, based on contractual agreements and payments received, and administers refunds accordingly. The Credit/Refund Specialist will be responsible for the expedient and accurate refund processing of patient and insurance over payments.

Essential Functions:

• Review EOBs and ensure allowances, adjustments, unallocated payments, and overpayments are posted correctly
• Reviews refund requests submitted by the billing team for accuracy, before sending to the accounting department for processing.
• Review and resolve accounts with credit balances/request refunds and/or adjustments as necessary
• Generate reports to identify outstanding credit balances and prepare overpayment packages as necessary
• Initiate and work up refund requests for overpayments
• Process refunds and credit balances to patients or payers
• Identify account problems, patterns, and trends
• Assist with additional payment-related functions as necessary
• Assist and respond to reports in a professional manner
• Comply with state/federal regulations and adhere to HIPAA and PHI guidelines
• Identify patient accounts with credit balances to determine whether or not a refund is due to the patient and/or insurance company.
• Communicate refund status with patients/insurance companies.
• Maintains refund tracking spreadsheet for all refund requests.
• Follow up on requests submitted to ensure payment has been received.
• Post adjustment and or payment corrections to patient accounts in billing software.
• Perform other duties as assigned to meet business needs

Qualifications and Education Requirements

· 2 years of experience working with medical refunds.

· High School Diploma or equivalent, Associate’s Degree preferred

· Previous healthcare billing and/or payment posting experience required.

• Basic computer knowledge (Windows, MS Word, MS Excel, Internet)
• Comfortable with computer use, online resources, and learning new software

· Understanding of Electronic Response Admittances (ERAs) and Explanation of Benefits (EOBs)

· Strong Attention to details

· 10 Key by touch.

· Excellent interpersonal skills including the ability to interact effectively and professionally with individuals at all levels; both internal and external.

· Must be able to work as part of a team.

Preferred Skills

· Knowledge of medical terminology

· Knowledge of health insurance

· Familiar with Chemotherapy and Radiation Billing

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Experience level:

• 2 years

Schedule:

• Monday to Friday

Education:

• High school or equivalent (Required)

Experience:

• medical refunds: 2 years (Required)
• Healthcare or payment posting: 2 years (Required)
• Explanation of Benefits (EOB's): 2 years (Required)
• Electronic Response Admittances (ERAs): 2 years (Required)

Ability to Commute:

• Nashville, TN (Required)

Work Location: In person