Refund Specialist I

US Acute Care Solutions•Virtual OH, OH

1d•$16 - $30•Remote

About The Position

The Refund Specialist I is responsible for thoroughly researching patient accounts to identify and resolve overpayments, ensuring accurate refund processing or correction of posting discrepancies within the Athena Billing System. This role requires detailed investigation of unapplied payments, coordination with internal systems, and effective communication with patients, payors, and team members to maintain financial accuracy and compliance.

Requirements

In-depth knowledge of payment processing functions, medical insurance, government payors, and related terminology.
Proficiency in using personal computers within a Windows environment, including spreadsheet applications and data entry tools.
Strong attention to detail with excellent problem-solving skills to identify and resolve discrepancies efficiently.
Effective verbal and written communication skills, maintaining professionalism and confidentiality at all times.
Ability to organize workload effectively, manage multiple tasks simultaneously, and adapt to changing priorities.
Willingness and ability to work overtime as needed to meet business demands.
High school diploma or equivalent required.
Experience with Insurance Websites/Portals/Overpayment Forms required.
Strong knowledge of Coordination of Benefits including Government and Commercial Carriers required.
Proficient in review of Explanation of Benefits and Posting required.
Strong knowledge in Payer initiated recoupments required.

Nice To Haves

Minimum of two years combined experience in medical insurance, payment processing, or insurance follow-up preferred.
Experience with AthenaOne Billing System is preferred but not mandatory.

Responsibilities

Investigate all requested refunds and credit balances by reviewing patient accounts for unapplied payments causing overpayments.
Verify payment application details on patient accounts to confirm accuracy.
Analyze internal deposit and payment batches to trace deposit origins and detect duplicate postings.
Utilize Cedar Patient Portal to confirm relevant payment information and initiate refunds when applicable.
Correct posting discrepancies in the Athena Billing System promptly and accurately.
Enter cases and document all necessary corrections within the Athena system.
Perform adjustments within guarantor accounts and process refunds as required.
Ensure claims are adjudicated correctly by understanding payer-side claim processes in Athena.
Maintain comprehensive notations in the system to facilitate clear communication and tracking of account activities.
Initiate refunds through Cedar Patient Portal or directly via Athena Billing System when portal processing is unavailable.
Execute complete refund check processes including reissue, void, and returned checks following established protocols.
Maintain organized backup documentation for all adjusted and refunded accounts to support audit readiness.
Communicate professionally and courteously with coworkers, management, third-party payors, and patients.
Assist with additional departmental duties as assigned to support overall team objectives.