RCM Refund Specialist

About the role

ROMTech is a medical technology company that has created and patented a revolutionary medical device and tele‑medical platform delivering in‑home rehabilitative care. Our disruptive technology yields faster recoveries, better outcomes, and unmatched patient compliance. Originally focused on orthopedics, we are scaling that business and expanding into cardiology and other adjacent markets, positioning ourselves as a global leader in the business, technology, and science of recovery.

Department: Revenue Cycle Management
Reports To: Collections Manager
Location / Work Environment: In‑office, Clearwater
Worker Classification: W‑2 Employee (Non‑Exempt, Standard Job Level)

Job Purpose

The Refund Specialist is responsible for reviewing, validating, and processing patient refunds and insurance overpayment requests in a timely and accurate manner. This position ensures compliance with payer contracts, organizational policies, and regulatory requirements while maintaining accurate account balances. The specialist conducts detailed account research to identify credit balances, determine refund eligibility, resolve discrepancies, and support the reduction of outstanding credits.

Key Responsibilities

• Review patient and insurance accounts with credit balances to determine refund eligibility and appropriate disposition.
• Process patient refunds, insurance overpayment refunds, and recoupment requests in accordance with established guidelines and timelines.
• Research accounts to identify the source of overpayments, duplicate payments, coordination of benefits issues, and payment posting errors.
• Validate refund requests by reviewing account activity, Explanation of Benefits (EOBs), Electronic Remittance Advice (ERA), payer contracts, and patient payment history.
• Ensure all refund requests are supported by appropriate documentation and approvals.
• Coordinate with billing, collections, cash posting, customer service, and insurance follow‑up teams to resolve account discrepancies affecting refund determinations.
• Respond to insurance carrier refund requests and audit inquiries related to overpayments.
• Monitor and work credit balance reports to ensure timely resolution of patient and insurance credits.
• Maintain detailed records of refund transactions and account research activities.
• Reconcile processed refunds and adjustments to ensure account accuracy.
• Identify trends contributing to overpayments and recommend process improvements to reduce future refund activity.
• Adhere to HIPAA, compliance standards, payer regulations, and organizational policies regarding refund processing.
• Assist with internal and external audits related to patient and insurance refunds.