Refunds Specialist

Job Summary

This position is responsible for identifying, addressing and quality auditing all aspects of overpayments and needed refunds. 

Major Responsibilities/Activities

• Identify when a refund is required
• Prepare a “packet” containing the essential paperwork to initiate a required refund 
• Monitor workflows to ensure the team’s established turnaround time goal is achieved or exceeded
• Maintain client-specific processes to achieve highest client satisfaction
• Coordinate with internal teams in the processing of recoupments and payment transfers
• Review internal company documents and make suggestions of required updates  
• Create new and update existing job aids and sops when needed for the Refund Department
• Quality audit team members refund paperwork to ensure the refund is compliant and the obligatory documents have been included 
• Provide feedback, coaching and training to business partners which perform tasks related to refunds
• Act as the liaison between the client, business partner and internal  
• Answer phone calls quickly and in a pleasant, professional manner 
• Professional written and oral communication to all clients, business partners and internal customers
• Consistently support and demonstrate the company mission and values

Other Responsibilities/Activities

• Deliver refund documents by email or the secured file transfer protocol ensuring PHI and financial documents are delivered to the correct recipient  
• Provide administrative support as directed
• Research and respond to inquiries in a timely manner   
• Perform other necessary tasks as assigned by manager
• Follow all HIPAA compliance guidelines 

Required Education, Skills, & Experience

• High School Diploma
• Intermediate Excel skills with the ability to manipulate data 
• Ability to collaborate effectively with multi-departmental and diverse teams 
• Strong, accurate typing and data entry skills
• Highly organized with ability to be proactive, manage time, and prioritize work with little supervision
• Willing and able to adapt to changes in work environment, procedures, priorities, schedule, and job duties

Preferred Education, Skills, & Experience

• Knowledge of HIPAA requirements and regulations
• Previous medical billing experience
• Understanding of Medicare, Medicaid, commercial, liability and patient reimbursement/billing 
• Solid understanding of insurance and liability payment methods and regulations

Working Environment/Physical Requirements

• General office environment
• Typing, sitting, standing, walking, some light lifting
• Use of basic office equipment such as computer, fax, printer, copier, telephone, scanner
• Infrequently required to work extended hours without advanced notice due to business needs