Insurance Refund Specialist

ICBD•Lauderdale Lakes, FL

About The Position

The Insurance Refund Specialist is responsible for reviewing, processing, appealing, and reconciling insurance overpayments and refunds within a healthcare organization. This role ensures compliance with payer regulations, internal policies, and accounting standards while maintaining accurate financial records. The specialist works closely with billing, collections, and accounting departments to identify and resolve credit balances in patient and insurance accounts. The principal functions of the position identified shall not be considered as a complete description of all the work requirements and expectations that may be inherent in the position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position.

Requirements

High school diploma or equivalent required; associate’s or bachelor’s degree in healthcare administration, accounting, or related field preferred.
2+ years of experience in medical billing, insurance, or managed care industry settling patient accounts or a related healthcare area
Experience with insurance refund processing, credit balance resolution, and payer correspondence preferred.
Strong analytical and problem-solving abilities.
Excellent attention to detail and organizational skills.
Proficiency in medical billing software and electronic health record (EHR) systems.
Knowledge of CPT, ICD-10, and insurance payment posting processes.
Ability to interpret Explanation of Benefits (EOBs) and payer remittance advice.
Effective written and verbal communication skills.

Responsibilities

Review insurance and patient accounts for credit balances and determine refund eligibility.
Research and analyze overpayments, duplicate payments, and payment posting errors.
Process refund requests in accordance with payer guidelines, organizational policies, and regulatory requirements.
Prepare and submit refund checks or electronic refund requests to insurance carriers or patients.
Communicate with insurance companies to confirm refund requirements and resolve discrepancies.
Document all refund and adjustment activities in the practice management or billing system.
Maintain compliance with HIPAA, payer contracts, and federal/state regulations related to refunds and overpayments.
Participate in audits and provide supporting documentation as needed.
Assist in developing and improving refund workflows to enhance efficiency and accuracy