Sr. Refund Account Specialist - Denial & Appeals Mgmt
Lakeland Regional Health, Lakeland, FL, United States
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 Level 2 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.
Lakeland Regional Health is currently seeking motivated individuals to join our team in various entry-level positions. Whether you're starting your career in healthcare or seeking new opportunities to make a difference, we have roles available across our primary and specialty clinics, urgent care centers, and upcoming standalone Emergency Department. With over 7,000 employees, Lakeland Regional Health offers a supportive work environment where you can thrive and grow professionally.
Active - Benefit Eligible and Accrues Time Off
Work Hours per Biweekly Pay Period:
80.00 Shift : Monday - Friday Location : 1324 Lakeland Hills Blvd Lakeland, FL Pay Rate : Min $18.82 Mid $23.53Position Summary 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.
Position Responsibilities
People At The Heart Of All We Do
Fosters an inclusive and engaged environment through teamwork and collaboration. Ensures patients and families have the best possible experiences across the continuum of care. Communicates appropriately with patients, families, team members, and our community in a manner that treasures all people as uniquely created. Safety And Performance Improvement
Behaves in a mindful manner focused on self, patient, visitor, and team safety. Demonstrates accountability and commitment to quality work. Participates actively in process improvement and adoption of standard work. Stewardship Demonstrates responsible use of LRH's resources including people, finances, equipment and facilities. Knows and adheres to organizational and department policies and procedures. 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.
Lakeland Regional Health is currently seeking motivated individuals to join our team in various entry-level positions. Whether you're starting your career in healthcare or seeking new opportunities to make a difference, we have roles available across our primary and specialty clinics, urgent care centers, and upcoming standalone Emergency Department. With over 7,000 employees, Lakeland Regional Health offers a supportive work environment where you can thrive and grow professionally.
Active - Benefit Eligible and Accrues Time Off
Work Hours per Biweekly Pay Period:
80.00 Shift : Monday - Friday Location : 1324 Lakeland Hills Blvd Lakeland, FL Pay Rate : Min $18.82 Mid $23.53Position Summary 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.
Position Responsibilities
People At The Heart Of All We Do
Fosters an inclusive and engaged environment through teamwork and collaboration. Ensures patients and families have the best possible experiences across the continuum of care. Communicates appropriately with patients, families, team members, and our community in a manner that treasures all people as uniquely created. Safety And Performance Improvement
Behaves in a mindful manner focused on self, patient, visitor, and team safety. Demonstrates accountability and commitment to quality work. Participates actively in process improvement and adoption of standard work. Stewardship Demonstrates responsible use of LRH's resources including people, finances, equipment and facilities. Knows and adheres to organizational and department policies and procedures. 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.