Refund Specialist I

Job Description

REQUIREMENTS

• High school diploma or equivalent required.
• Minimum of two years combined experience in medical insurance, payment processing, or insurance follow-up preferred.
• Experience with Insurance Websites/Portals/Overpayment Forms required.
• Strong knowledge of Coordination of Benefits including Government and Commercial Carriers required.
• Proficient in review of Explanation of Benefits and Posting required.
• Strong knowledge in Payer initiated recoupments required.
• Experience with AthenaOne Billing System is preferred but not mandatory.

RESPONSIBILITES

• Investigate all requested refunds and credit balances by reviewing patient accounts for unapplied payments causing overpayments.
• Verify payment application details on patient accounts to confirm accuracy.
• Analyze internal deposit and payment batches to trace deposit origins and detect duplicate postings.
• Utilize Cedar Patient Portal to confirm relevant payment information and initiate refunds when applicable.
• Correct posting discrepancies in the Athena Billing System promptly and accurately.
• Enter cases and document all necessary corrections within the Athena system.
• Perform adjustments within guarantor accounts and process refunds as required.
• Ensure claims are adjudicated correctly by understanding payer-side claim processes in Athena.
• Maintain comprehensive notations in the system to facilitate clear communication and tracking of account activities.
• Initiate refunds through Cedar Patient Portal or directly via Athena Billing System when portal processing is unavailable.
• Execute complete refund check processes including reissue, void, and returned checks following established protocols.
• Maintain organized backup documentation for all adjusted and refunded accounts to support audit readiness.
• Communicate professionally and courteously with coworkers, management, third-party payors, and patients.
• Assist with additional departmental duties as assigned to support overall team objectives.

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