Refund Specialist- REMOTE - (Must Reside in FL)

Summary

Florida Orthopaedic Institute is seeking a Refund Specialist to research patient accounts and determine whether refunds are warranted. The role focuses on reviewing insurance payments and EOBs, resolving credit balances, processing accurate refunds and adjustments, maintaining regulatory compliance, and supporting revenue integrity.

Responsibilities

• Review and analyze patient account activity to determine appropriate refund actions
• Review explanation of benefits (EOBs) related to refund requests, overpayments, recoupments, and forward balances
• Apply patient payment transfers, charge corrections, contractual adjustments, and refunds accurately
• Work all payments daily and ensure monies are applied correctly
• Resolve credit balances through refunds, adjustments, transfers, or other appropriate actions
• Contact insurance payers to obtain additional information regarding coordination of benefits, contractual adjustments, and patient responsibility
• Apply federal and state prompt payment regulations to validate or invalidate insurance refund requests when applicable
• Identify payment variances, underpayments, recovery opportunities and communicate findings to leadership
• Identify payer trends or workflow issues contributing to credit balances and notify management
• Ensure all validated government payer refund requests are processed within required payer guidelines
• Maintain daily, weekly, and monthly quantitative and qualitative production standards
• Coordinate work assignments with peers to ensure timely completion of departmental responsibilities
• Communicate effectively with Business Office staff, leadership, and affiliated departments to fulfill information requests
• Respond to emails from Business Office, leadership, and assigned cases within 48 hours
• Perform all duties in compliance with Medicare, federal, state, contractual agreements, and OSM internal policies
• Maintain strict confidentiality of PHI and always comply with HIPAA regulations
• All other duties as assigned

Skills

• High School Diploma or equivalent required
• Minimum of 3–5 years of experience in medical reimbursement, healthcare insurance collections, patient accounting, medical collections, or a similar role within a medical or physician practice
• Minimum of 3–5 years of experience resolving credit balances, performing account reconciliation, processing refunds, identifying variances, and analyzing payment trends
• Strong experience collecting payments from insurance carriers required
• Proficiency with EMR/EHR systems and the Microsoft Office Suite; basic Microsoft Excel skills required
• College coursework or degree preferred
• Experience as a payment poster preferred but not required
• Strong understanding of medical terminology, CPT/HCPCS procedure codes, ICD diagnosis codes, and insurance terminology
• Knowledge of payer reimbursement methodologies and contract language, including Medicare, Medicaid, Workers' Compensation, Managed Care, exclusions, case rates, percentages of charges, and fee schedules
• Experience in orthopedic healthcare reimbursement highly preferred
• Proficiency in interpreting explanation of benefits (EOBs) and tracing payer offsets, recoupments, and forward balances
• Knowledge of basic accounting and mathematical principles, including the ability to calculate reimbursements and refund amounts
• Strong written and verbal communication skills with the ability to interact professionally across departments and with external payers
• Excellent attention to detail and a high level of accuracy
• Strong organizational and time-management skills with the ability to prioritize work, multitask, and adapt to change
• Ability to work independently while collaborating effectively with team members
• Exercises discretion, sound judgment, and professionalism in all business relationships

Qualifications

Must Haves

• High School Diploma or equivalent required
• Minimum of 3–5 years of experience in medical reimbursement, healthcare insurance collections, patient accounting, medical collections, or a similar role within a medical or physician practice
• Minimum of 3–5 years of experience resolving credit balances, performing account reconciliation, processing refunds, identifying variances, and analyzing payment trends
• Strong experience collecting payments from insurance carriers required
• Proficiency with EMR/EHR systems and the Microsoft Office Suite; basic Microsoft Excel skills required

Nice to Haves

• college coursework or degree preferred
• Experience as a payment poster preferred but not required
• Strong understanding of medical terminology, CPT/HCPCS procedure codes, ICD diagnosis codes, and insurance terminology
• Knowledge of payer reimbursement methodologies and contract language, including Medicare, Medicaid, Workers' Compensation, Managed Care, exclusions, case rates, percentages of charges, and fee schedules
• Experience in orthopedic healthcare reimbursement highly preferred
• Proficiency in interpreting explanation of benefits (EOBs) and tracing payer offsets, recoupments, and forward balances
• Knowledge of basic accounting and mathematical principles, including the ability to calculate reimbursements and refund amounts
• Strong written and verbal communication skills with the ability to interact professionally across departments and with external payers
• Excellent attention to detail and a high level of accuracy
• Strong organizational and time-management skills with the ability to prioritize work, multitask, and adapt to change
• Ability to work independently while collaborating effectively with team members
• Exercises discretion, sound judgment, and professionalism in all business relationships

Benefits

• Remote work arrangement for employees residing in Florida.