RCM Refund Specialist

ROM Technologies, Inc.; Clearwater (FL); On-site; USD 42,000 - 64,000; Full time

Job summary

ROMTech is seeking a Refund Specialist in Clearwater, FL to review, validate, and process patient refunds and insurance overpayments in a timely and accurate manner from our in-office environment. You will ensure compliance with payer contracts and organizational policies while maintaining accurate account balances.

Collaborating with billing, collections, and care teams, you will validate refund requests, monitor credit balances, and help resolve discrepancies.

Responsibilities

• Review patient and insurance accounts with credit balances to determine refund eligibility and appropriate disposition.
• Process patient refunds, insurance overpayment refunds, and recoupment requests in accordance with established guidelines and timelines.
• Research accounts to identify the source of overpayments, duplicate payments, coordination of benefits issues, and payment posting errors.
• Validate refund requests by reviewing account activity, EOBs, ERA, payer contracts, and patient payment history.
• Ensure all refund requests are supported by appropriate documentation and approvals.
• Coordinate with billing, collections, cash posting, customer service, and insurance follow-up teams to resolve account discrepancies affecting refund determinations.
• Respond to insurance carrier refund requests and audit inquiries related to overpayments.
• Monitor and work credit balance reports to ensure timely resolution of patient and insurance credits.
• Maintain detailed records of refund transactions and account research activities.
• Reconcile processed refunds and adjustments to ensure account accuracy.
• Identify trends contributing to overpayments and recommend process improvements to reduce future refund activity.
• Adhere to HIPAA, compliance standards, payer regulations, and organizational policies regarding refund processing.
• Assist with internal and external audits related to patient and insurance refunds.

Job description

At ROMTech, we are transforming rehabilitation through innovative technology and exceptional patient support. We are committed to helping patients achieve better outcomes through Clinician guided at-home rehab while delivering an outstanding experience throughout their recovery journey.

ROMTech is a medical technology company that has created and patented a revolutionary medical device and telemedical platform which delivers in-home rehabilitative care. Our disruptive technology has proven to yield faster recoveries and better outcomes with unmatched patient compliance. We began in orthopedics and have entered scale-up of our orthopedic business. We are now leveraging our core technology, infrastructure, and first mover position to enter cardiology, followed by other adjacent markets. Having created this new lane, we have a unique opportunity to serve as the global leader in the business, technology, and science of recovery, and to bring life-changing help to many millions of people.

Position Title: Refund Specialist

Department: Revenue Cycle Management

Reports To: Collections Manager

Location / Work Environment: In Office, Clearwater

Worker Classification: W-2 Employee

FLSA Status: Non-Exempt

Job Level: Standard

Job Purpose

The Refund Specialist is responsible for reviewing, validating, and processing patient refunds and insurance overpayment requests in a timely and accurate manner. This position ensures compliance with payer contracts, organizational policies, and regulatory requirements while maintaining accurate account balances. The specialist conducts detailed account research to identify credit balances, determine refund eligibility, resolve discrepancies, and support the reduction of outstanding credits.

Key Responsibilities

Essential Duties

• Review patient and insurance accounts with credit balances to determine refund eligibility and appropriate disposition.
• Process patient refunds, insurance overpayment refunds, and recoupment requests in accordance with established guidelines and timelines.
• Research accounts to identify the source of overpayments, duplicate payments, coordination of benefits issues, and payment posting errors.
• Validate refund requests by reviewing account activity, Explanation of Benefits (EOBs), Electronic Remittance Advice (ERA), payer contracts, and patient payment history.
• Ensure all refund requests are supported by appropriate documentation and approvals.
• Coordinate with billing, collections, cash posting, customer service, and insurance follow-up teams to resolve account discrepancies affecting refund determinations.
• Respond to insurance carrier refund requests and audit inquiries related to overpayments.
• Monitor and work credit balance reports to ensure timely resolution of patient and insurance credits.
• Maintain detailed records of refund transactions and account research activities.
• Reconcile processed refunds and adjustments to ensure account accuracy.
• Identify trends contributing to overpayments and recommend process improvements to reduce future refund activity.
• Adhere to HIPAA, compliance standards, payer regulations, and organizational policies regarding refund processing.
• Assist with internal and external audits related to patient and insurance refunds.