Refund Specialist I

Job Description

• Thoroughly research patient accounts to identify and resolve overpayments
• Process accurate refunds and correct posting discrepancies within the Athena Billing System
• Investigate refunds and credit balances by reviewing unapplied payments
• Verify payment application details on patient accounts
• Analyze internal deposit and payment batches to trace deposit origins and detect duplicate postings
• Use Cedar Patient Portal to confirm payment information and initiate refunds
• Enter cases and document corrections within the Athena system
• Perform guarantor-account adjustments and process refunds
• Ensure claims are adjudicated correctly by understanding payer-side claim processes in Athena
• Maintain comprehensive system notations for communication and account tracking
• Execute refund check processes, including reissue, void, and returned checks
• Maintain backup documentation for adjusted and refunded accounts for audit readiness
• Communicate with coworkers, management, third-party payors, and patients
• Assist with additional departmental duties as assigned

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, and overpayment forms required
• Strong knowledge of Coordination of Benefits, including government and commercial carriers required
• Proficient in reviewing Explanations of Benefits and posting required
• Strong knowledge of payer-initiated recoupments required
• Experience with AthenaOne Billing System preferred but not mandatory
• In-depth knowledge of payment processing functions, medical insurance, government payors, and related terminology
• Proficiency with personal computers in a Windows environment, including spreadsheet applications and data-entry tools
• Strong attention to detail and problem-solving skills
• Effective verbal and written communication skills with professionalism and confidentiality
• Ability to organize workload, manage multiple tasks, and adapt to changing priorities
• Willingness and ability to work overtime as needed
• Ability to sit for extended periods and occasionally walk, stand, bend, stoop, and lift up to 15 pounds
• Close visual acuity required to perform duties accurately

Benefits

• Medical, dental, and vision insurance options
• Health savings accounts (HSA) and flexible spending accounts (FSA)
• 401(k) employee and employer contributions
• Paid time off, including vacation, sick leave, and company holidays
• Paid parental leave & family support benefits
• Short-term and long-term disability insurance
• Life and accidental death & dismemberment (AD&D) insurance
• Employee assistance programs & wellness resources
• Bonus eligibility, equity, or other incentive programs, depending on the role
• Supportive culture
• Competitive compensation package
• Unlimited paths for advancement