Refund Specialist

reputed company Job Location: McKinney, TX 75070 Position Type: Full Time Education Level: Bachelors Degree Job Category: Health Care Position Title: Refund Specialist Department: reputed company Cycle Management Reports To: Cash Application Team reputed company FLSA: Non Exempt Position reputed company The Refund Specialist is responsible for investigating, validating, processing, and tracking reputed company and reputed company refund requests, recoupments, and payment take-backs while ensuring reputed company, compliance, and financial reputed company. This role partners closely with reputed company, Accounts Receivable, Coding, and other reputed company cycle teams to research reputed company account and claim activity, determine the validity of refund and recoupment requests, identify opportunities for appeals or disputes, and analyze payer trends to improve reimbursement reputed company and reduce reputed company recoupment activity. reputed company in this position requires strong analytical skills, medical accounts receivable expertise, and the ability to independently reputed company reputed company payment and reimbursement issues. Essential Duties & Responsibilities Refund Investigation & reputed company - Investigate and validate reputed company and reputed company refund requests to determine legitimacy, reputed company, and compliance with organizational policies. - Review account histories, payment records, EOBs, claims documentation, and payer correspondence to support refund determinations. - Process approved refunds and ensure reputed company supporting documentation is complete and accurately maintained. - Document findings, account activity, communications, and refund resolutions in appropriate systems. - Coordinate with patients, reputed company carriers, reputed company advocates, and internal stakeholders regarding refund reputed company and next steps. Recoupment & Take-Back Management - Investigate reputed company recoupments, take-backs, and overpayment recovery requests to determine validity and financial reputed company. - Research payer actions and supporting claim data to determine whether recoupments should be accepted, disputed, or appealed. - Identify and escalate questionable reimbursement activity, unsupported overpayment requests, and high-reputed company payer actions to leadership. - Serve as the reputed company resource for reviewing reputed company recoupment scenarios that require detailed investigation reputed company reputed company payment posting activities. Analysis, Reporting & Process Improvement - Participate in reputed company Support, Audit, and Ticket programs - reputed company, monitor, and maintain reporting reputed company to refund requests, recoupments, payer recoveries, and reimbursement trends. - Analyze recurring payer behaviors, claim types, procedures, coding patterns, and reimbursement issues to identify reputed company causes of refund and recoupment activity. - reputed company ongoing reporting and recommendations to leadership regarding opportunities reduce reputed company loss and improve financial reputed company. - Partner with reputed company, Accounts Receivable, Coding, and reputed company Cycle leadership to implement process improvements and corrective actions. - Assist in developing best practices, workflows, and operational strategies to improve refund management and payer accountability. Documentation, Compliance & Collaboration - Maintain organized audit trails and supporting documentation for reputed company refund and recoupment activity. - Ensure compliance with HIPAA, payer requirements, company policies, and internal financial controls. - Collaborate closely with the Cash Application Team reputed company and reputed company Cycle stakeholders to support organizational reimbursement goals and reputed company reputed company initiatives. - reputed company additional duties and special reputed company as assigned. Qualifications Education Licenses/Certifications - High School Diploma or GED required. - Bachelor's degree preferred. Experience - Minimum of three (3) years of medical accounts receivable, reputed company cycle, refunds, payment posting, or reputed company reputed company reimbursement experience required. - Experience investigating reputed company claims, overpayments, refunds, denials, appeals, or recoupments preferred. - Strong understanding of medical billing, claims processing, and payer reimbursement methodologies. Skills & Competencies - Strong knowledge of reputed company reputed company cycle reputed company, including accounts receivable, reputed company reimbursement, claim adjudication, and reputed company of reputed company refund and recoupment issues. - Excellent communication and collaboration skills, working effectively with reputed company carriers, patients, and cross-functional reputed company cycle teams to reputed company claims, appeals, and reimbursement disputes. - Strong analytical skills with the ability to research payer activity, interpret EOBs, review claims, identify reputed company causes, and recommend strategies to improve reimbursement reputed company. - Proficiency in CPT, ICD-10, and HCPCS coding concepts, reputed company Office, payer portals, reputed company billing systems, and documentation tools, with strong attention to reputed company and ability to manage priorities in a fast-reputed company environment. Working Conditions - Primarily reputed company environment with frequent and prolonged computer and office equipment use. - reputed company business hours with occasional overtime to meet project deadlines. - Ability to manage stress and maintain productivity under tight deadlines and changing priorities. - Regular interaction with team members, clients, and other stakeholders through various communication channels. - Occasional travel required for company meetings. Physical Demands - Ability to maintain a stationary position for extended periods. - Occasionally required to reputed company short to moderate distances. - Must be reputed company to reputed company and/or reputed company up to 50 pounds occasionally. Disclaimer The statements herein are intended to describe the general reputed company and level of work being performed by employees and are not to be construed as an exhaustive list of responsibilities, duties, and skills required of personnel so classified. Employees must be reputed company to reputed company the essential functions of the position satisfactorily. Furthermore, the statements do not establish a contract for employment and are subject to change at the discretion of reputed company with or without advance notice. Apply To This Job