Revenue Cycle Specialist III Refund Analyst

E.N.T. Specialty Partners•Irving, TX

25d•Onsite

About The Position

The Revenue Cycle Specialist III Refund Analyst researches, analyzes, reconciles, and resolves credit balances in patient and insurance accounts to maintain accurate financial records and support timely, appropriate refunds. The role identifies causes of credit balances, corrects payment discrepancies, and issues refunds in accordance with payer guidelines, contractual obligations, organizational policies, approval requirements, financial controls, and applicable regulations. The position requires strong analytical and problem-solving skills, attention to detail, knowledge of medical billing and accounts receivable processes, and the ability to independently manage a high-volume workload while meeting productivity, accuracy, and turnaround-time expectations. The analyst reviews account histories, insurance remittance advice (ERA/EOB), payment transactions, contractual adjustments, and claim details to determine how to resolve credit balances. Before processing refunds, the analyst verifies claim adjudication, refund eligibility, the correct recipient and amount, and that outstanding claims, balances, and adjustments have been addressed. The role maintains thorough account documentation and refund tracking records in the EHR or practice management system, monitors pending requests and approvals, and escalates complex discrepancies or financial risks to leadership. The position also requires adherence to departmental procedures, organizational policies, payer requirements, HIPAA, and state and federal regulations. The analyst maintains confidential patient and financial information, supports audit and regulatory documentation, identifies recurring errors and workflow deficiencies, and takes responsibility for the accuracy and integrity of assigned work. The role is located at the ESP Executive Offices in Dallas, Texas; travel is not required.

Requirements

High school diploma or GED.
At least 2 years of experience in medical billing, accounts receivable, payment posting, credit balance resolution, or insurance refund processing; listed as preferred in the posting.
Working knowledge of medical billing procedures, insurance reimbursement methodologies, and patient accounting processes.
Understanding of ERA/EOB, contractual adjustments, coordination of benefits (COB), and payer reimbursement guidelines.
Experience researching payment discrepancies, overpayments, and account reconciliation issues.
Proficiency with electronic health record (EHR) systems and medical practice management software.
Strong computer skills, including Microsoft Excel, Outlook, and other Microsoft Office applications.
Ability to interpret detailed financial transactions and accurately calculate refund amounts.
Strong written and verbal communication skills.
Ability to work independently while meeting established productivity and quality expectations.
Ability to work at a computer for extended periods and accurately review detailed financial records and account documentation.
Ability to manage multiple assignments in a deadline-driven environment.
Maintain confidentiality of patient, financial, and organizational information.
Regular and reliable attendance and adherence to established work schedules.

Nice To Haves

Additional education in healthcare administration, medical billing, or a related field.
Experience with eClinicalWorks (eCW) or comparable practice management systems.
Previous experience processing patient and insurance refunds in a multi-practice healthcare environment.
Knowledge of Medicare, Medicaid, commercial insurance, and managed care reimbursement requirements.
Experience with credit balance aging reports, refund tracking systems, and accounts receivable reconciliation.
Familiarity with electronic payment posting, 835 files, and insurance remittance processing.
Experience identifying and correcting payment posting errors, duplicate payments, and unapplied credits.
Certified Professional Biller (CPB), Certified Revenue Cycle Specialist (CRCS), or similar healthcare revenue cycle certification.

Responsibilities

Review, research, and resolve credit balances on patient and insurance accounts.
Investigate causes of credit balances, including duplicate payments, overpayments, incorrect contractual adjustments, payment posting errors, insurance coordination issues, and patient overpayments.
Analyze account histories, ERA/EOBs, payment transactions, contractual adjustments, and claim details to determine appropriate resolutions.
Verify that applicable insurance claims have been accurately processed and adjudicated before initiating refunds.
Correct credit balances through appropriate payment transfers, adjustments, or account corrections when permitted.
Resolve credit balances accurately and promptly to prevent aging, financial discrepancies, and compliance concerns.
Document research findings, account corrections, and resolution actions in the practice management system.
Research, validate, and process patient, insurance, and third-party refund requests in accordance with SOPs.
Determine appropriate refund recipients and amounts by reviewing payment histories, insurance benefits, contractual agreements, and account activity.
Verify refund eligibility and confirm outstanding claims, balances, and payment adjustments have been addressed before processing.
Prevent duplicate refunds, incorrect payment reversals, and refunds to unauthorized recipients.
Apply and document refund transactions accurately in the EHR or practice management system.
Monitor refund requests, pending approvals, and outstanding transactions for timely completion.
Maintain refund tracking records and supporting documentation for audit and reconciliation purposes.
Escalate complex refund discrepancies, potential financial risks, and unresolved issues to leadership as appropriate.
Follow departmental SOPs, organizational policies, payer requirements, approval requirements, financial controls, and applicable state and federal regulations.
Protect confidential patient and financial information in compliance with HIPAA.
Maintain documentation supporting internal audits, external reviews, and regulatory compliance.
Identify recurring errors, workflow deficiencies, and potential compliance risks and communicate findings to leadership.
Follow escalation procedures for unusual account activity, potential duplicate payments, or significant financial discrepancies.
Demonstrate accountability for the accuracy, completeness, and integrity of assigned work.