Job Title: Refund Posting & Recovery Analyst
Job Summary
We are seeking a detail-oriented Refund Posting & Recovery Analyst with healthcare claims processing experience. Prior experience with AMISYS claims processing systems is highly preferred, as it will enable a smoother transition into the role. The analyst will be responsible for reviewing, validating, processing, and posting claim-related refunds while ensuring compliance with healthcare regulations, quality standards, and internal procedures.

Key Responsibilities
Receive and review refund checks and initiate refund analysis.
Retrieve claim information from the Recovery Application and claims processing systems.
Verify member, provider, and claim details against refund documentation.
Review and validate refund reasons to ensure accuracy and compliance.
Process refund transactions following established procedures and state-specific requirements.
Determine whether refunds are full or partial based on claim payment history and status.
Process recoupments and adjustment transactions as required.
Monitor refund transactions through completion, including posting and finalization activities.
Reconcile claims, payments, and refund transactions to ensure accuracy.
Research and resolve refund, recovery, and payment discrepancies.
Maintain accurate records and documentation of refund activities.
Adhere to HIPAA regulations, quality standards, and organizational policies.

Required Qualifications
Experience in healthcare claims processing, refund posting, or recovery operations.
Basic understanding of healthcare claims adjudication and payment workflows.
Knowledge of refunds, overpayments, recoupments, and recovery processes.
Familiarity with Explanation of Benefits (EOBs) and payment reconciliation.
Experience using healthcare claims processing systems and related applications.
Strong analytical and problem-solving skills.
Excellent attention to detail and accuracy in handling financial transactions.
Ability to meet productivity and quality standards in a fast-paced environment.
Strong verbal and written communication skills.
Working knowledge of HIPAA compliance and confidentiality requirements.

Refund Posting & Recovery Analyst

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