Remote Medical Refunds Specialist

Job Summary 

The Remote Medical Refunds Specialist processes refunds to patient and insurance accounts and prepares daily credit balance reports, using computer systems, databases and ledgers. Supports in the reconciling, correction, and/or completion of contractual adjustments, insurance refunds, and patient refunds. Responsible for Web based discrepancy refunds and RN lines to logging system. Is flexible in work priorities and performs other duties as assigned.

As a Remote Medical Refunds Specialist  at Community Health Systems (CHS) - Patient Access Center, you’ll play a vital role in supporting our purpose to help people get well and live healthier by providing safe, quality healthcare, building enduring relationships with our patients, and providing value for the people and communities we serve. Our team members enjoy a robust benefits package including medical, dental, and vision insurance, paid time off (PTO), 401(k) with company match, tuition reimbursement, and more

Essential Functions

• Processes refunds to patient and insurance accounts.
• Maintaining appropriate knowledge and understanding of all Managed Care Contracts and Federal payors.
• Work overpayments, request for refund letters, faxes and telephone requests.
• Utilizes various computer systems and databases to complete analyze accounts.
• Reviews daily Credit Balance reports to analyze issues causing credit balances. Corrects contractual adjustment amount, if needed. Compiles refund request with appropriate documentation, if applicable.
• Ensures compliance procedure for prompt recording/processing of all refunds.
• Communicates any refund issues with Reimbursement Manager/Supervisor as needed.
• Answer questions via email from the Facilities, TSSC Customer Service and PASI regarding credits, refunds, and account discrepancies.
• Statutes Government credit for reporting to Corporate.
• Identifies accounts to be escheated to the state.
• Monitors accounts for State Statue Waiting Period.
• Researches credit balance accounts to determine if a payor or patient has overpaid on the account.
• Prices claims using contracts, pricers, and payment methodologies to validate refund requests from payors.

Qualifications

• H.S. Diploma or GED required
• 1-3 years of experience in accounts receivable experience in hospital or medical setting, required
• 1-3 years of experience in experience working with Managed Care Contracts preferred and Federal programs, preferred
• Experience with payer reimbursement policies, claim adjudication, and healthcare revenue cycle operations preferred

Knowledge, Skills and Abilities

• Ability to analyze account balances, identify discrepancies, and apply appropriate adjustments.
• Proficiency in electronic health records (EHR), billing software, and reimbursement systems.
• Strong problem-solving and critical-thinking skills, ensuring accurate claims resolution.
• Effective communication and collaboration skills, working with payers, revenue cycle teams, and internal departments.
• Knowledge of HIPAA, compliance regulations, and healthcare reimbursement sta