Refunds Sr. Specialist

Position Summary

The Sr. RCM Specialist – Credits is responsible for resolving overdue credit and debit balances due from insurance carriers and patients. This role ensures compliance with organizational policies, state, and federal regulations while auditing accounts, issuing refunds, and identifying practice trends for process improvement. The Specialist also serves as a mentor and resource for practices and new employees.

Essential Job Duties

• Review credit balances for all practices, identify trends, and notify stakeholders with recommendations for improvement.

• Conduct thorough audits of patient credit accounts; issue refunds in compliance with company policy and applicable laws.

• Prioritize workload to achieve timely and meaningful results.

• Ensure insurance payments are accurate; issue adjustments in accordance with regulations and protocol.

• Monitor and respond to the refund inbox promptly.

• Administer all refund processes, including check refunds, inbox management, chargebacks, and credit accounts.

• Mentor practices and new employees; provide education on company standards, insurance requirements, and compliance regulations.

• Create and maintain contact notes and audit records, including Explanation of Benefits (EOB) files.

• Perform additional duties as assigned by manager or director.

Qualifications and Skills

• Demonstrated resourcefulness and adaptability.

• Ability to manage multiple priorities with frequent interruptions.

• Strong oral and written communication skills.

• Ability to meet deadlines consistently.

• Knowledge of collection laws and regulations.

• Strong problem-solving and interpersonal skills.

Education and Experience

• High School Diploma or equivalent required.

• Minimum of 2 years’ experience in a medical and/or dental Revenue Cycle environment, or equivalent combination of education and experience.

Travel Requirements

• Travel is not required for this role.

Physical Requirements

• Prolonged periods of sitting required.

• Occasional lifting and bending to carry boxes and supplies, up to 25 pounds.