Insurance Refund Specialist in Dickson, Tennessee at Dickson Medical Associates, PC

SUMMARY: Under the direction of the Director, Business Office, An Insurance Refund Specialist is responsible for auditing, researching, and processing credit balances and overpayments owed to insurance companies, or third-party payors.

Key Essential Duties and Responsibilities (Duties include, but are not limited to, the following):

• Credit & Ledger Auditing: Review internal billing ledgers to identify accounts with credit balances and determine whether the overpayment was made by the insurance provider or the patient.
• Insurance Research: Analyze Explanations of Benefits (EOBs) and Electronic Remittance Advices (ERAs) to verify correct contractual allowances, copays, deductibles, and coordination of benefits (COB).
• Refund Request Processing: Prepare, verify, and submit accurate refund documentation to commercial payors, Medicare, and Medicaid.
• Recoupment Management: Review and process insurance recoupment demands, ensuring takebacks are accurately reflected in the practice management software.
• System Management: Post adjustments, write-offs, and refund transactions directly into the practice’s EHR/billing software (e.g., Epic).
• Compliance Maintenance: Ensure all transactions adhere to HIPAA standards, individual insurance contracts, and state laws regarding unclaimed property/escheatment.

JOB QUALIFICATIONS

• Demonstrated knowledge of healthcare billing, collections, payer processes, and account resolution.
• 1–3 years of experience working specifically within a private medical practice, physician group, or outpatient clinic environment
• Commitment to patient confidentiality, professional conduct, customer service, and organizational policies.
• Hands-on experience with medical practice management systems and standard office software (particularly Excel for tracking spreadsheets).

EDUCATION & EXPERIENCE

• High school diploma or equivalent required; associate or bachelor’s degree in healthcare administration, finance, or a related field preferred.
• 1 to 3+ years of combined experience in medical billing, insurance follow-up, or payment processing.
• Proficiency with Microsoft Office, particularly Excel and Word.
• Strong written and verbal communication skills and the ability to work with limited supervision.
• Epic experience is preferred.
• Strong analytical and problem-solving abilities, high attention to detail, and clear written/verbal communication skills

PHYSICAL DEMANDS

The physical demands described below are representative of those required to perform the essential functions of this position. Reasonable accommodation may be made for qualified individuals with disabilities.

• Regularly stand, walk, sit, use hands to handle objects or controls, reach, speak, and hear.
• Occasionally stoop, kneel, crouch, crawl, and lift or move up to 25 pounds.
• Use close, distance, color, peripheral, and depth vision, with the ability to adjust focus.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those encountered while performing the essential functions of this position. Reasonable accommodation may be made in accordance with applicable law.

EQUAL OPPORTINITY EMPLOYER - Dickson Medical Associates is an Equal Opportunity Employer.