Position Details Lakeland Regional Health is a leading medical center located in Central Florida. With a legacy spanning over a century, we have been dedicated to serving our community with excellence in healthcare. As the only designated Level 1 Trauma Center for Polk, Highlands, and Hardee counties, and the second busiest Emergency Department in the US, we are committed to providing high-quality care to our diverse patient population.
Our facility is licensed for 910 beds and handles over 200,000 emergency room visits annually, along with 49,000 inpatient admissions, 21,000 surgical cases, 4,000 births, and 101,000 outpatient visits. Active - Benefit Eligible and Accrues Time Off Work Hours per Biweekly Pay Period: 80.00
Monday - Friday 8:00 am to 4:30 pm Location : 1324 Lakeland Hills Blvd Lakeland, FL Pay Rate : Min $18.82 Mid $23.53
The Senior Refund Account Specialist is responsible for managing and processing patient and insurance refund requests in accordance with contract terms, payer guidelines, and internal policies. This role ensures timely resolution of credit balances, disputes invalid refund requests, maintains audit compliance, and collaborates across departments to resolve payment discrepancies.
Standard Work: Sr. Refund Account Specialist Refund Review & Compliance Review daily refund requests for completeness, accuracy, and alignment with contract terms across government, commercial, and private payers. Analyze EOBs, correspondence, and contract/fee schedules to validate overpayments.
Overpayment Disputes Respond to insurance companies or third-party vendors within set timeframes to prevent recoupments or offsets. Submit and follow up on refund disputes through various channels (mail, email, web portals). Coordination with Departments Collaborate with departments including Billing, HIMS, CDM, Cash Posting, and Managed Care to resolve credit and overpayment issues.
Escalate and report recurring billing or payer issues to leadership. Insurance Payer Communication Contact insurance payers and third-party vendors to verify, dispute, or follow up on refunds and adjustments. Monitor payer trends and credit activity, advising management of irregularities.
Refund Processing Process patient and insurance refund requests accurately in the Patient Accounting system. Prepare documentation for management approval and coordinate with Accounts Payable for check processing. Credit Balance Management Investigate credit balances in the Patient Accounting system to determine root causes.
Complete necessary adjustments, transfer payments appropriately, and resolve voided balances. Identify and Resolve EOB Payment Variances Investigate, review and resolve EOB Variances for both overpayments and underpayments Escalate and report payer trends and issues to leadership Reporting & Reconciliation Maintain and reconcile monthly reports including A/R follow-up, Medicare quarterly credit balance reports, and Medicaid audits.
Perform reconciliation for receipt summaries, unclaimed property, and unidentified cash. Patient and Vendor Communication Handle inbound inquiries from patients, payers, and vendors via phone, email, and written correspondence. Compliance & Documentation Maintain accurate and complete documentation for audits and internal reviews.
Ensure compliance with HIPAA and internal confidentiality standards. Other Duties Perform other duties as assigned in support of departmental goals. Competencies & Skills Essential: Proficiency in Microsoft Word, Excel, Outlook.
Strong communication skills (written and verbal). Detail-oriented with the ability to prioritize and multi-task. Problem-solving and analytical skills.
Ability to work effectively with cross-functional teams, patients, and external vendors. Qualifications & Experience Essential: High School or Equivalent Other information: Experience Essential: - 3–5 years in accounting, medical billing, or patient accounts. - Strong understanding of payer reimbursement methodologies and terminology (e.g., contractual adjustment, coinsurance, denials). - Familiarity with Cerner Patient Accounting or similar systems.