Refunds & Credit Balances 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

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.