Staff Position Description

Position Title: Refund Specialist

Department: Patient Financial Services

Reports to: CBO Cash Applications Manager 

Position Purpose:

All KHI employees are expected to perform their respective tasks and duties in such a way that supports KHI’s vision to be among the kindest, highest quality health systems in the country.

Key Responsibilities:

• Prepares Refund Request Forms and supporting documentation to ensure that refunds are issued accurately and promptly.

• Performs follow-up on checks that have not cleared the bank and research checks that are returned for insufficient address.

• Follows state specific unclaimed property laws when submitting uncashed refund checks to the appropriate state annually.

• Facilitates voids, reissues, and stop payment requests with facility Accounts Payable Department.

• Maintains HIPAA patient confidentiality standards for medical and financial information.

• Review and respond to various patient and insurance refund/offset requests.

• Reporting & Analysis: Contribute to overall team and departmental objectives by providing insights from refund data; identify trends in refund requests to recommend improvements in products, services, or internal processes to minimize future cancellations and enhance customer experience.

• Identifies situations in which contractual adjustments are warranted by determining the original billed amounts as compared to the amounts allowed and prescribed by Medicare / Medicaid and/or managed care contracts, as applicable.

• Performs other duties as assigned to support overall effectiveness of department and organization

Qualifications:

Education: High School Diploma or Equivalent

  Experience: 

• One (1) or more years of experience in medical billing, accounts receivable(AR), or cash reconciliation in a hospital or clinic setting.
• One (1) or more years of experience in healthcare billing.

 Certification/Licensure:  N/A

Skills and Knowledge: 

• Demonstrates thorough knowledge of medical terminology, medical procedural (CPT) and diagnosis (ICD-9) coding, billing, collections, denials, and payment posting workflow. 
• Basic working knowledge of personal computers and their associate user software is required. Experience with Microsoft Office products Word and Excel is preferred.
• Ability to multi-task while working on multiple responsibilities simultaneously. 
• Demonstrated ability to read and analyze an Explanation of Benefits (EOB) or Electronic Remittance Advice (ERA)
• Familiarity with hospital billing (UB-04) and Physician billing (CMS-1500) 
• Knowledge of commercial, Medicare, Medicaid, and managed care payer processes.
• Basic accounting principles for balancing and reconciling payments.
• Knowledge of general ledger postings and adjustments.

Preferences: N/A

Work Requirements:

Blood Borne Disease Exposure Category: Category III

Ability to sit for six to seven hours daily at a computer terminal; occasionally lifts and carries up to 15 pounds of files to storage area; must be able to deal calmly and effectively with frustrated and/or angry clients.

Date Staff Position Description Created / Revised: 02/22/2019; 9/18/2026