RCM Refund Specialist

At ROMTech, we are transforming rehabilitation through innovative technology and exceptional patient support. We are committed to helping patients achieve better outcomes through Clinician guided at-home rehab while delivering an outstanding experience throughout their recovery journey.

ROMTech is a medical technology company that has created and patented a revolutionary medical device and telemedical platform which delivers in-home rehabilitative care. Our disruptive technology has proven to yield faster recoveries and better outcomes with unmatched patient compliance. We began in orthopedics and have entered scale-up of our orthopedic business. We are now leveraging our core technology, infrastructure, and first mover position to enter cardiology, followed by other adjacent markets. Having created this new lane, we have a unique opportunity to serve as the global leader in the business, technology, and science of recovery, and to bring life-changing help to many millions of people.

Position Title: Refund Specialist
Department: Revenue Cycle Management
Reports To: Collections Manager
Location / Work Environment: In Office, Clearwater
Worker Classification: W-2 Employee
FLSA Status: Non-Exempt
Job Level: Standard

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

Essential Duties

- 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.

Qualifications

JOB QUALIFICATIONS

Skills and Abilities

Required

- Strong verbal and written communication skills.

- Excellent customer service and patient relationship management abilities.

- Ability to explain complex billing and reimbursement information in a patient-friendly manner.

- Strong attention to detail and organizational skills.

- Ability to manage sensitive financial discussions with professionalism, empathy, and discretion.

- Proficiency with Microsoft Office applications and computer-based systems.

- Strong problem-solving and account resolution skills.

- Ability to maintain confidentiality and handle protected information appropriately.

- Ability to prioritize work and manage multiple accounts simultaneously.

Work Experience Requirements

Required

- Minimum 5 years of experience in healthcare revenue cycle, medical billing, refunds, credit balance resolution, or accounts receivable.

- Strong understanding of insurance reimbursement methodologies, EOBs, ERAs, and payer guidelines.

- Knowledge of Medicare, Medicaid, commercial insurance, and patient payment processes.

- Experience researching and resolving patient and insurance credit balances.

- Proficiency in Microsoft Office Suite, particularly Excel.

- Experience with healthcare billing and practice management systems.

- Strong analytical, organizational, and problem-solving skills.

- Excellent attention to detail and accuracy.

Education Requirements

Required

- None identified as legally, regulatorily, accreditation, payer, or externally required.

Preferred

- High school diploma or equivalent.

License and Certification Requirements

Required

- None identified as legally, regulatorily, accreditation, payer, or externally required.

Preferred

- Certified Revenue Cycle Representative (CRCR), Certified Patient Account Representative (CPAR), or similar revenue cycle certification.

Physical Demands and Working Conditions

Office

The following describes the physical demands and work environment characteristics required to perform the essential functions of this position. These requirements are representative of those an employee may encounter while performing the job and are not intended to be an exhaustive list. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the role.

- Ability to sit at a computer terminal for an extended period.

- Moderate noise (i.e., phone calls, online meetings, computer audio).

- While performing the duties of this job, the employee may be regularly required to stand, sit, talk, hear, reach, stoop, kneel, and use hands and fingers to operate a computer, telephone, and keyboard.

- Specific vision abilities required by this job include close vision requirements due to computer work.

- Regular, predictable attendance is required.

- Must be able to communicate clearly and professionally in both verbal and written formats.

- Must be able to engage in active listening and express ideas effectively in person, by phone, and via virtual meetings.

- The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

- Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Reasonable accommodation requests must be made in writing by emailing [email protected].