REFUND AND RECOUPMENT SPECIALIST

Definition and Role

Under the direction of the Assistant Director of Revenue Cycle – Revenue Recovery, the Refund and Recoupment Specialist is responsible for managing and processing overpayments, refunds, and payer recoupment requests accurately and timely. This role ensures compliance with internal policies, payer regulations, and federal/state guidelines while supporting the financial integrity of the healthcare organization.

Job Responsibilities and Duties

• Review and resolve daily work queues for patient and payer credit balances.
• Process patient refund requests according to internal policy and payer contract terms.
• Submit and track insurance refund checks and electronic transactions.
• Work payer recoupment notices, coordinating with AR and billing teams to validate overpayments.
• Investigate misapplied payments, duplicate postings, and incorrect adjustments, correcting accounts as needed.
• Analyze refund requests for potential fraudulent or inappropriate refund activity.
• Reconcile refund batches and ensure general ledger accuracy in partnership with finance teams.
• Maintain accurate and up-to-date documentation of refund activity in the billing system.
• Collaborate with payers to validate takebacks and ensure correct reallocation of funds.
• Communicate refund status updates to patients, providers, and internal departments professionally.
• Escalate complex or disputed refund and recoupment cases to leadership when needed.
• Monitor trends in overpayments and contribute to process improvement efforts.
• Stay current on Medicare, Medicaid, and commercial payer regulations for refunds and recoupments.
• Assist with audits and respond to external and internal audit documentation requests.

Key Skills & Competencies:

• Knowledge of healthcare revenue cycle and medical billing practices
• Strong understanding of EOBs, ERAs, credit balances, and overpayments
• Proficiency in Excel and billing platforms (Epic, eCW, Cerner, etc.)
• Analytical thinker with attention to detail and problem-solving abilities
• Excellent verbal and written communication skills
• Time management and organizational skills in a deadline-driven environment
• Familiarity with payer-specific refund and recoupment procedures
• Ability to maintain confidentiality and work with sensitive financial and patient data
• Strong team collaboration and independent work skills
• Adaptability in handling changes in policies or technologies

Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing this job the employee is frequently required to sit, talk and hear.
2. The employee is occasionally required to walk, use hands and fingers to feel, handle, or operate objects, tools, or controls, and reach with hands and arms.
3. The employee must occasionally lift and/or move objects weighing up to 25 pounds.
4. Specific vision abilities required by this job include close vision and the ability to adjust and focus.
5. Emotional/Psychological: Constant ability to make decisions and concentrate.

Qualifications

• Educa