Refund Specialist

UPMC; Pittsburgh (Allegheny County); On-site; USD 25,000 - 36,000; Full time

Job summary

UPMC is seeking a Refunds Processor to handle credit balances for refunds, including insurance and self-pay accounts. You will review balances, ensure government payer refunds meet guidelines, and attach documentation to refund requests.

Responsibilities include prioritizing work by aging, reconciling postings, and addressing trends in workflow. A high school diploma with 1–3 years in claims, billing, or business office is required; a Bachelor's is preferred.

Qualifications

• High School diploma or equivalent; 1 year claims processing, billing or collections experience or 3 years in a business office setting.
• Knowledgeable in third party payer guidelines and reimbursement practices required.
• Effective problem solving skills and ability to make independent decisions.
• Good oral and written communication skills.
• Knowledge of medical terminology and reimbursement practices.

Responsibilities

• Review credit balances for possible distribution to other debit balances.
• Ensure that all validated Government payer refunds are processed timely per payer guidelines.
• Maintain department productivity guidelines.
• Attach proper documentation to all refund requests.
• Promote UPMC core values in all interactions; maintain compliance with quality standards.
• Prioritize workflow by balance and aging criteria; process incoming refund requests within 3 business days.
• Identify and resolve credit accounts through refunds, adjustments, or payments; adhere to applicable laws.
• Reconcile refund postings; notify management of trends creating credit balances.

Skills

Claims processing

Billing

Customer service

Communication

Microsoft Office

Education

High School diploma or equivalent

Bachelor's degree preferred

Tools

Patient accounting systems

Microsoft Office

Job description

Purpose

Process all credit balances (insurance and self-pay) for refunds.

Purpose

Process all credit balances (insurance and self-pay) for refunds.

Responsibilities

• Review credit balances for possible distribution to other debit balances.
• Ensure that all validated Government payer refunds are processed in a timely manner or within the payer guidelines.
• Maintain department productivity guidelines.
• Ensure that proper documentation is attached to all refund requests.
• Performs duties and job responsibilities in a manner which promotes the core values of UPMC (Quality and Safety, Dignity and Respect, Caring and Listening, Excellence and Innovation, Responsibility and Integrity) in all consumer and UPMC interactions.
• Maintain compliance with quality standards.
• Prioritize work flow accordingly by balance and aging criteria.
• Ensure that all incming refund requests, either via CRM or email, are processed within 3 business days.
• Identify and take action towards resolution of credit accounts through potential refunds, adjustments, payment transfers, etc. Adhere to the Fair debt Extension Uniformity Act and understand the laws and regulations applicable to job functions.
• Identify credit balance issues that may impact workflow.
• Reconcile refund postings.
• Notify management of any trends identified in workflow creating credit balances.
• High School diploma or equivalent and 1 year of claims processing, billing or collections experience, OR High School diploma or equivalent and 3 years experience in a business office setting.
• Bachelor's degree is preferred.
• Knowledgeable in third party payer guidelines and reimbursement practices required.
• Effective problem solving skills and ability to make independent decisions required.
• Good oral and written communication skills.
• Knowledge of medical terminology, third party payer guidelines and reimbursement practices.
• Experience or working knowledge of Microsoft Office products (Word, Outlook, Excel) preferred but not required.
• Strong understanding of all patient accounting systems.

Licensure, Certifications, and Clearances

• Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran