Revenue Cycle Specialist III Refund Analyst

E.N.T. Specialty Partners•Dallas, TX

24d

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 ensure timely refund processing. The role identifies the causes of credit balances, corrects payment discrepancies, and processes appropriate refunds in line with payer guidelines, contractual obligations, organizational policies, and regulatory requirements. The specialist independently manages a high-volume workload while meeting productivity, accuracy, and turnaround-time expectations. The position reviews account histories, insurance remittance advice (ERA/EOB), payment transactions, contractual adjustments, and claim details; confirms claims have been accurately processed and adjudicated; and determines whether balances should be resolved through refunds, payment transfers, adjustments, or other account corrections. It researches and validates patient, insurance, and third-party refund requests, verifies recipients and amounts, prevents duplicate or unauthorized refunds, and records transactions and supporting documentation in an EHR or practice management system. The specialist monitors pending requests, approvals, and outstanding transactions, escalating complex discrepancies and potential financial risks as appropriate. The role requires adherence to departmental procedures, organizational policies, payer requirements, financial controls, and applicable regulations, including HIPAA. It also supports audit and reconciliation needs by maintaining accurate records, identifying recurring errors and workflow deficiencies, and communicating compliance risks to leadership. Work involves extended computer use, detailed financial record review, and managing multiple assignments in a deadline-driven setting. Regular and reliable attendance and adherence to work schedules are required.

Requirements

High school diploma or GED required.
Minimum of 2 years of experience in medical billing, accounts receivable, payment posting, credit balance resolution, or insurance refund processing preferred.
Working knowledge of medical billing procedures, insurance reimbursement methodologies, and patient accounting processes.
Understanding of ERA/EOBs, contractual adjustments, coordination of benefits (COB), and payer reimbursement guidelines.
Experience researching payment discrepancies, overpayments, and account reconciliation issues.
Proficiency with 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 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.
Ability to 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 root 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 account resolution.
Verify that applicable insurance claims have been processed and adjudicated before initiating refunds.
Correct credit balances through permitted payment transfers, adjustments, or account corrections.
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 according to established 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 applicable payment adjustments are 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 to support 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 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 complete and accurate account documentation to support audits, external reviews, and regulatory compliance.
Identify recurring errors, workflow deficiencies, unusual account activity, potential duplicate payments, and compliance risks, and communicate or escalate findings as appropriate.
Take accountability for the accuracy, completeness, and integrity of assigned work.
Manage multiple assignments in a deadline-driven environment and adhere to established work schedules.