PURPOSE STATEMENT 

The Refund Specialist is responsible for processing refund requests, ensuring they meet company policy, and maintaining accurate records of all transactions. This role involves reviewing payer contracts to ensure that the requested refund is accurate. It also involves reviewing accounts for accurate payment and adjustment posting per the insurance Remittance Advice.

ESSENTIAL FUNCTIONS

• Use AIDET when greeting patients/customers either on the phone or in person.
• Review and process refund requests from customers and insurance payers.
• Review and process refund Credit Balances for insurance payers.
• Verify eligibility of refunds in accordance with company policies and procedures.
• Calculate refund amounts accurately, ensuring proper adjustments and payment posting.
• Review payer contracts to ensure that the refund is accurate based on our contracts.
• Communicate with patients and insurance payers regarding refund status, inquiries, or disputes.
• Respond to insurance payers and resolve refund-related issues in a timely and professional manner.
• Identify trends in refund requests and recommend improvements to reduce refund claims.
• Suggest enhancements to the refund process to improve efficiency and customer satisfaction.
• Assist patients/customers with the concerns and questions on all bills from WMMC and WMMC clinics, as assigned.  

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS

• High school diploma or equivalent.
• Previous medical billing/coding experience.
• Good understanding of medical insurance billing/coding.
• Contract Management Experience a plus.
• Must be self-motivated and have the ability to work within the established policies, procedures and practices prescribed by the hospital/clinic.

PHYSICAL/MENTAL REQUIREMENTS

• Must be able to sit and stand, intermittent 8 to 10 hours a day.
• Must be able to use standard office equipment, including the telephone and computer keyboard.
• Continuously works under pressure of near 100% accuracy while meeting inflexible deadlines.
• Continuously utilizes manual/bi-manual dexterity, near vision, speech, and hearing.
• Frequently stands, walks, sits and utilizes eye/hand coordination and color definition.
• Occasionally reaches above shoulder, regularly required to life and/or carry up to 40 lbs.
• Occasionally walks on uneven surfaces.
• Ability to travel 1% of the time, including flying and driving rental cars.
• To accommodate travel, must be able to transport own suitcases and portable computer estimated at 5 pounds.