Hospital Credit & Refund Specialist

UC San Diego; San Diego (CA); Remote; USD 65,000 - 86,000; Full time

Benefits offered by this job

Remote work option

Job summary

UC San Diego Health's Revenue Cycle department is seeking a Credit Refund Specialist to research and resolve hospital credit balances, refund requests, and related adjustments. This role requires strong hospital billing knowledge, attention to detail, and the ability to determine refund eligibility based on claim history and payer guidance.

The position supports accurate reimbursement, compliance with refund processing standards, and timely communication with payers and internal departments.

Qualifications

• Three (3) years of acute care hospital billing, collections, payer follow-up, credit balance, refund, or account resolution experience.
• State and Federal rules and regulations related to facility medical insurance billing, claim processing, and refund handling.
• Demonstrated knowledge reviewing and resolving hospital claim errors, payment discrepancies, account balances, and payer correspondence.
• Thorough knowledge of UB04 and revenue codes as it pertains to hospital billing and reimbursement.
• Extensive knowledge in submission of hospital claims appeals and basic knowledge in medical terminology, ICD9, CPT, HCPCS coding principles.
• Demonstrated knowledge of facility reimbursement contracts and reimbursement methodologies including per diem, fee schedule, case rate and DRG's.

Responsibilities

• Analyze hospital insurance credit balance accounts to ensure timely identification, validation, resolution, and issuance of accurate refunds when appropriate.
• Review insurance refund requests, payer correspondence, remittance activity, claim history, adjustments, and payment activity to determine whether a refund is supported.
• Review and interpret hospital payer contracts and reimbursement methodologies to verify expected reimbursement and identify discrepancies such as overpayments, underpayments, duplicate payments, or incorrect payer calculations.
• Research and resolve account credit balances related to coordination of benefits, retroactive eligibility changes, payer recoupments, duplicate payments, contract adjustments, payment posting discrepancies, and billing corrections.
• Respond professionally and effectively to inquiries from payers and internal departments regarding account balances, refund statuses, payment activity, and account resolution.
• Process insurance refund requests accurately and compliantly according to payer requirements, organizational standards, and applicable state and federal regulations.
• Identify, analyze, and resolve billing discrepancies, claim errors, payment variances, and account issues related to credit balances and refunds.
• Collaborate with internal teams, including billing, denials, payment posting, revenue integrity, contracting, coding, and patient access, to support accurate reimbursement and account reconciliation.
• Maintain clear, accurate, and compliant account documentation supporting refund decisions, account actions, and escalation outcomes.
• Maintain compliance with HIPAA regulations and ensure confidentiality and security of patient information throughout the refund and credit balance process.

Skills

Acute care billing

Payer follow-up

Credit balance experience

Refund processing

UB04 knowledge

HIPAA compliance

Attention to detail

Effective communication

Tools

Payer portals

Document imaging systems

Clearinghouse tools

Job description

UC San Diego Health's Revenue Cycle department is seeking a Credit Refund Specialist to research and resolve hospital credit balances, refund requests, and related adjustments. This role requires strong hospital billing knowledge, attention to detail, and the ability to determine refund eligibility based on claim history and payer guidance.

The position supports accurate reimbursement, compliance with refund processing standards, and timely communication with payers and internal departments.