Job Description
Job DescriptionJob Summary
The Credit Refund Specialist plays a critical role within the Revenue Cycle Management (RCM) function by ensuring credit balances are accurately researched, resolved, and refunded in accordance with payer rules, contractual requirements, and internal controls. This position requires a high level of attention to detail and extensive account-level research to determine whether refunds are owed to insurance companies or patients, or if credit balances resulted from payment posting errors, incorrect adjustments, duplicate payments, or billing discrepancies. The role requires a strong Account Representative background and a solid understanding of insurance plans, explanation of benefits, coordination of benefits, and downstream RCM impacts to ensure credits are properly resolved before refunds are issued.
Key Responsibilities
- Review customer or patient accounts to identify credit balances and determine refund eligibility
- Process refunds accurately and timely via check or offset
- Reconcile credit balances and ensure proper application of payments and adjustments
- Research discrepancies, overpayments, and billing errors to resolve refund issues
- Communicate with customers, patients, insurance companies, and internal departments regarding refunds
- Maintain detailed documentation and audit trails for all refund transactions
- Ensure compliance with company policies, contractual agreements, and applicable regulations
- Collaborate with billing, collections, account representatives, and accounting teams to resolve account issues
- Prepare reports related to credit balances, refunds, and account reconciliation
- Respond to inquiries regarding refund status professionally and promptly
Qualifications
- High school diploma or equivalent required
- 1–3 years of experience in AR claims follow up, payment posting
- Strong Account Representative background with hands-on experience managing patient and insurance accounts
- Demonstrated familiarity with commercial, Medicare, and Medicaid insurance plans, including payer rules, explanation of benefits, and coordination of benefits
- Strong attention to detail and accuracy
- Proficiency in Microsoft Excel and financial or billing systems
- Ability to analyze account data and resolve discrepancies
- Strong organizational and time-management skills
- Excellent written and verbal communication skills
Preferred Skills
- Experience with the following EMR systems; EPIC, Nextgen, Athena
- Knowledge of refund regulations, compliance standards, and internal controls
- Prior experience working closely with insurance follow-up, denials, and payment posting
Work Environment
- In- office only
- Requires prolonged periods of computer use and data entry
Compensation
- Competitive salary based on experience
- Benefits package including health insurance, paid time off, and retirement options