[Hiring] Medical Refunds Specialist @Community Health Systems Professional Services Corporation

Role Description

As a Remote Refunds Specialist at Community Health Systems (CHS) - Shared Services Center, you’ll play a vital role in quality healthcare, building enduring relationships with our patients, and providing value for the people and communities we serve.

The Remote Medical Refunds Specialist processes refunds to patient and insurance accounts and prepares daily credit balance reports, using computer systems, databases and ledgers. Supports in the reconciling, correction, and/or completion of contractual adjustments, insurance refunds, and patient refunds. Responsible for Web based discrepancy refunds and RN lines to logging system. Is flexible in work priorities and performs other duties as assigned.

Essential Functions

• Processes refunds to patient and insurance accounts.
• Maintaining appropriate knowledge and understanding of all Managed Care Contracts and Federal payors.
• Work overpayments, request for refund letters, faxes and telephone requests.
• Utilizes various computer systems and databases to complete analyze accounts.
• Reviews daily Credit Balance reports to analyze issues causing credit balances.
• Corrects contractual adjustment amount, if needed.
• Compiles refund request with appropriate documentation, if applicable.
• Ensures compliance procedure for prompt recording/processing of all refunds.
• Communicates any refund issues with Reimbursement Manager/Supervisor as needed.
• Answers questions via email from the Facilities, TSSC Customer Service and PASI regarding credits, refunds, and account discrepancies.
• Statutes Government credit for reporting to Corporate.
• Identifies accounts to be escheated to the state.
• Monitors accounts for State Statue Waiting Period.
• Researches credit balance accounts to determine if a payor or patient has overpaid on the account.
• Prices claims using contracts, pricers, and payment methodologies to validate refund requests from payors.

This is a fully remote opportunity.

Qualifications

• H.S. Diploma or GED required.
• 1-3 years of experience in accounts receivable experience in hospital or medical setting, required.
• 1-3 years of experience in experience working with Managed Care Contracts preferred and Federal programs, preferred.
• Experience with payer reimbursement policies, claim adjudication, and healthcare revenue cycle operations preferred.

Knowledge, Skills and Abilities

• Ability to analyze account balances, identify discrepancies, and apply appropriate adjustments.
• Proficiency in electronic health records (EHR), billing software, and reimbursement systems.
• Strong problem-solving and critical-thinking skills, ensuring accurate claims resolution.
• Effective communication and collaboration skills, working with payers, revenue cycle teams, and internal departments.
• Knowledge of HIPAA, compliance regulations, and healthcare reimbursement standards.

Benefits

• Paid Time Off (PTO)
• Comprehensive Health Benefits - Medical, Dental & Vision
• 401k with company match
• Tuition reimbursement

Company Description

Community Health Systems is one of the nation's leading healthcare providers. With healthcare delivery systems in 36 distinct markets across 14 states, CHS operates 69 affiliated hospitals with more than 10,000 beds and approximately 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, imaging centers, cancer centers, and ambulatory surgery centers.

This position is not eligible for immigration sponsorship now or in the future. Applicants must be authorized to work in the U.S. for any employer.