Refund Collection Analyst

The Refund Collection Analyst provides day-to-day operational support and leadership within RCM Refunds and Billing.

Responsibilities:

• Lead patient and payer refund processing in accordance with RCM policies, payer guidelines, and internal controls.
• Resolve complex refund, billing, and claim-related issues, including overpayments, duplicate payments, improper charges, and payment discrepancies.
• Perform account reconciliations to identify and resolve discrepancies, unapplied payments, credit balances, and other outstanding account issues.
• Audit patient and payer accounts to identify billing errors, validate transactions, determine refund eligibility, and initiate appropriate corrective actions.
• Monitor refunds and billing-related complaints, reconciliation issues, and workflow trends, escalating systemic or recurring issues to management.
• Partner cross-functionally with RCM, Finance, Enrollment, Billing, and Customer Service to resolve refund, billing, payment, and reconciliation issues and improve operational processes.
• Serve as an escalation resource for complex refund, billing, and account reconciliation matters while supporting day-to-day workflow needs.
• Track refund volumes, reconciliation results, audit findings, aging, and operational trends and provide updates to management during weekly and month-end reporting.
• Provide audit feedback, process guidance, and remedial training to team members as needed.
• Support workflow standardization by identifying process gaps, recommending improvements, and helping ensure established procedures and internal controls are followed.
• Complete day-to-day Enrollment/Billing responsibilities independently, with access to management or more experienced team members for guidance on complex or unusual matters.
• Complete other projects and duties as assigned.

Qualifications:

• Must be a current employee or contractor with The Cigna Group, Evernorth Health Services, or one of their subsidiaries.
• High school diploma or GED required; Bachelor's degree in finance or related field preferred.
• MDLive experience preferred.
• Working knowledge of RCM refund policy.
• Strong analytical and problem-solving skills with the ability to identify effective and efficient solutions.
• Experience reviewing financial transactions and resolving billing or payment discrepancies is preferred.
• Proficiency in working with Microsoft Office products: Excel, Word.
• Working knowledge of Health Insurance EOB's.
• Ability to meet assigned deadlines.
• Strong understanding of the claims cycle.
• Capable of finding effective and efficient solutions to challenges.
• Must be able to work in a fast-paced, high-volume work environment.