RCM Facilitator

A Refund Specialist is responsible for identifying, processing, and resolving patient and payer overpayments in accordance with payer contracts, federal/state regulations, and organizational policies. This role ensures accurate refund issuance, appropriate account adjustments, and thorough documentation while collaborating with billing, cash posting, denials, and customer service teams to maintain clean accounts receivable and reduce refund aging.

Key Responsibilities

· Review and research credit balances, duplicate payments, payment reversals, and other overpayment scenarios to determine appropriate resolution.

· Validate refunds through payer portals, remittance advice (ERA/EOB), explanation of benefits, and internal billing/account notes.

· Initiate and process refunds to patients and third-party payers in accordance with established approval thresholds and internal controls.

· Prepare and submit refund requests, supporting documentation, and correspondence to payers (including recoupment or refund forms) as required.

· Post and/or coordinate appropriate account adjustments, transfers, and write-offs per policy to accurately reflect refund activity.

· Maintain detailed documentation of research, communications, and actions taken to support audit readiness and compliance.

· Monitor refund aging/work queues; prioritize work to meet timeliness requirements and performance goals.

· Coordinate with Cash Posting, Billing, Denials, Patient Financial Services, and Customer Service to resolve complex accounts and prevent repeat issues.

· Identify refund trends (e.g., incorrect charge entry, eligibility/coverage issues, coordination of benefits, contract misconfiguration) and recommend process improvements.

· Ensure adherence to HIPAA and data privacy standards when handling protected health information (PHI).

· Support internal and external audits by providing refund logs, supporting documentation, and status updates.

Required Qualifications

· High school diploma or equivalent (associate degree in business, healthcare administration, or related field preferred).

· 1–3 years of experience in healthcare revenue cycle, billing, cash posting, refunds, or accounts receivable.

· Working knowledge of insurance types (commercial, Medicare, Medicaid) and remittance advice (ERA/EOB) interpretation.

· Proficiency with electronic health record (EHR) and/or practice management/billing systems and Microsoft Office (Excel, Word, Outlook).

· Strong analytical and problem-solving skills with attention to detail and accuracy.

· Ability to manage multiple priorities, meet deadlines, and work independently within established guidelines.

· Professional written and verbal communication skills for interactions with payers, patients, and internal stakeholders.

Preferred Qualifications

· Experience processing payer and patient refunds at scale, including refund approvals and segregation-of-duties controls.

· Familiarity with payer portals, coordination of benefits (COB), and recoupment/dispute workflows.

· Advanced Excel skills (pivot tables, VLOOKUP/XLOOKUP, filters) for refund tracking and reconciliation.

· Experience with common billing platforms (e.g., Epic, Cerner, athenahealth, eClinicalWorks, NextGen) or similar systems.

· Knowledge of state unclaimed property/escheatment processes related to uncashed refund checks.

Core Competencies

· Credit balance analysis and account research

· Refund processing and reconciliation

· Documentation, audit readiness, and compliance

· Customer service and payer communication

· Confidentiality and HIPAA awareness

· Time management and workload prioritization

Work Environment

This position typically works in an office setting with extensive computer and telephone use.