Refund Specialist I
About The Position
The Refund Specialist I researches patient accounts to identify and resolve overpayments and ensures accurate refund processing or correction of posting discrepancies in the Athena Billing System. The role investigates unapplied payments, coordinates information across internal systems, and communicates with patients, payors, and team members to maintain financial accuracy and compliance. This is a remote position. The specialist reviews account payment applications, traces deposits and payment batches, corrects discrepancies, documents account activity, and processes refunds and refund checks according to established protocols. The role also maintains supporting documentation for audit readiness and assists with other departmental duties as assigned.
Requirements
- High school diploma or equivalent required.
- Experience with insurance websites, portals, and overpayment forms required.
- Strong knowledge of Coordination of Benefits, including government and commercial carriers, required.
- Proficiency in reviewing Explanation of Benefits and posting required.
- Strong knowledge of payer-initiated recoupments required.
- Knowledge of payment processing functions, medical insurance, government payors, and related terminology.
- Proficiency using personal computers in a Windows environment, including spreadsheet applications and data-entry tools.
- Strong attention to detail and problem-solving skills.
- Effective verbal and written communication skills, with professionalism and confidentiality.
- Ability to organize workload, manage multiple tasks, and adapt to changing priorities.
- Willingness and ability to work overtime as needed to meet business demands.
Nice To Haves
- Minimum of two years' combined experience in medical insurance, payment processing, or insurance follow-up preferred.
- Experience with the AthenaOne Billing System preferred but not mandatory.
Responsibilities
- Investigate requested refunds and credit balances by reviewing patient accounts for unapplied payments that may cause overpayments.
- Verify payment application details on patient accounts.
- Analyze internal deposit and payment batches to trace deposit origins and identify duplicate postings.
- Use the Cedar Patient Portal to confirm payment information and initiate refunds when applicable.
- Correct posting discrepancies in the Athena Billing System and enter cases documenting necessary corrections.
- 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 system notations for clear communication and account-activity tracking.
- Initiate refunds through the Cedar Patient Portal or Athena Billing System when portal processing is unavailable.
- Complete refund check processes, including reissues, voids, and returned checks, following established protocols.
- Maintain organized backup documentation for 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.
Benefits
- Medical, dental, and vision insurance options
- Health savings accounts (HSA) and flexible spending accounts (FSA)
- 401(k) employee and employer contributions
- Paid time off, including vacation, sick leave, and company holidays
- Paid parental leave and family support benefits
- Short-term and long-term disability insurance
- Life and accidental death and dismemberment (AD&D) insurance
- Employee assistance programs and wellness resources
- Possible bonus eligibility, equity, or other incentive programs, depending on the role
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
