Refund Specialist: Revenue Cycle & Credit Resolution

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

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.