Refund Specialist

Position Title: Refund Specialist Department: Revenue Cycle Management Reports To: Cash Application Team Lead FLSA: Non Exempt Position Summary The Refund Specialist is responsible for investigating, validating, processing, and tracking insurance and patient refund requests, recoupments, and payment take-backs while ensuring accuracy, compliance, and financial integrity. This role partners closely with Cash Posting, Accounts Receivable, Coding, and other revenue cycle teams to research complex account and claim activity, determine the validity of refund and recoupment requests, identify opportunities for appeals or disputes, and analyze payer trends to improve reimbursement outcomes and reduce future recoupment activity. Success in this position requires strong analytical skills, medical accounts receivable expertise, and the ability to independently resolve complex payment and reimbursement issues. Essential Duties & Responsibilities Refund Investigation & ResolutionInvestigate and validate insurance and patient refund requests to determine legitimacy, accuracy, and compliance with organizational policies.Review account histories, payment records, EOBs, claims documentation, and payer correspondence to support refund determinations.Process approved refunds and ensure all supporting documentation is complete and accurately maintained.Document findings, account activity, communications, and refund resolutions in appropriate systems.Coordinate with patients, insurance carriers, patient advocates, and internal stakeholders regarding refund decisions and next steps.Recoupment & Take-Back ManagementInvestigate insurance recoupments, take-backs, and overpayment recovery requests to determine validity and financial impact.Research payer actions and supporting claim data to determine whether recoupments should be accepted, disputed, or appealed.Identify and escalate questionable reimbursement activity, unsupported overpayment requests, and high-risk payer actions to leadership.Serve as the primary resource for reviewing complex recoupment scenarios that require detailed investigation beyond standard payment posting activities.Analysis, Reporting & Process ImprovementParticipate in Clinical Support, Audit, and Ticket programsTrack, monitor, and maintain reporting related to refund requests, recoupments, payer recoveries, and reimbursement trends.Analyze recurring payer behaviors, claim types, procedures, coding patterns, and reimbursement issues to identify root causes of refund and recoupment activity.Provide ongoing reporting and recommendations to leadership regarding opportunities reduce revenue loss and improve financial outcomes. Partner with Cash Posting, Accounts Receivable, Coding, and Revenue Cycle leadership to implement process improvements and corrective actions.Assist in developing best practices, workflows, and operational strategies to improve refund management and payer accountability.Documentation, Compliance & CollaborationMaintain organized audit trails and supporting documentation for all refund and recoupment activity.Ensure compliance with HIPAA, payer requirements, company policies, and internal financial controls.Collaborate closely with the Cash Application Team Lead and Revenue Cycle stakeholders to support organizational reimbursement goals and revenue integrity initiatives.Perform additional duties and special projects as assigned.