Refund Specialist

About the Company

Ventra Health provides business support services for physicians and clinical groups working in anesthesia, emergency medicine, hospital medicine, pathology, and radiology. The organization specializes in revenue cycle management and works with private practices, hospitals, health systems, and ambulatory surgery centers to deliver clear, data-led solutions for complex billing and reimbursement challenges, helping clinicians stay focused on patient care.

Role Overview

The Refund Specialist is responsible for tracking, reviewing, and processing patient and insurance refunds, with a focus on credit balances and billing overages.

Key Responsibilities

• Investigate credit balances and process refunds generated from overpayments in the billing system.
• Review refund request letters and decide the correct resolution based on contract terms and timely filing rules.
• Spot recurring patterns in refund activity and escalate them to the relevant teams.
• Use online payer portals and websites to retrieve Explanation of Benefits information.
• Reach out to insurance carriers to confirm refund-related details.
• Study data from multiple reports and share recommendations based on findings.
• Handle assigned special projects and other related duties as needed.

Education and Experience

• High school diploma or an equivalent qualification is required.
• At least 2 years of experience posting insurance payments in a healthcare environment is required.
• 2 years of experience reviewing Explanation of Benefits statements is preferred.

Skills and Competencies

• Understanding of Explanation of Benefits documents.
• Familiarity with different insurance plan types.
• Strong verbal, written, and interpersonal communication ability.
• Proficiency with word processing, spreadsheets, and database tools.
• Good command of arithmetic, including percentages and decimal calculations.
• Effective time management and prioritization skills.
• Strong organization and attention to detail.
• Ability to interpret and follow state and federal rules, regulations, and policies.
• Proactive problem-solving and troubleshooting mindset.
• Adaptability in a fast-moving, collaborative environment.
• Professional and tactful communication with a wide range of people.

Compensation and Incentives

The base pay will be determined by factors such as location, experience, qualifications, skills, and other job-related considerations. The role is also eligible for a discretionary incentive bonus under company policy. It additionally participates in a performance-based incentive plan, and employees may qualify for a referral bonus under the rewards and recognition program.

Additional Information

Ventra Health is an equal opportunity employer in the US and supports a workplace built on diversity, inclusion, and mutual respect. Reasonable accommodations may be provided to qualified individuals with disabilities to help them perform essential job duties.

Recruitment and Safety Notice

The company does not accept unsolicited agency resumes and is not responsible for any fees tied to them. It also does not request payment from applicants for hiring or placement. Candidates should be cautious of fraudulent approaches from individuals pretending to represent Ventra Health or affiliated entities. To verify legitimacy, contact [email protected]. Official roles are posted on Ventra Health’s careers page.

Accessibility

Ventra Health states that it is committed to improving digital accessibility for all users and continues to work toward better accessibility standards and user experience.