Refund Analyst Team Lead

HaloMD

Who We Are: 

HaloMD specializes in Independent Dispute Resolution (IDR) through The No Surprises Act and state regulations for out-of-network healthcare providers, leveraging advanced technology and deep industry expertise to secure optimized reimbursements.

Job Summary:

Refund management is a critical aspect of a business's operational framework, focusing on the process of handling and processing customer refunds. This is the process of overseeing and facilitating the return of dispute funds from IDRE’s for prevailing disputes for our customers. It involves establishing policies, procedures, and systems to efficiently handle refund requests and maintain customer satisfaction. This position will be reporting to Refund Compliance Director and is responsible for the end-to-end refund process. This includes completion of daily reconciliation and maintaining accurate weekly reporting, mentoring team members, and training incoming Refund Analysts. The Refund Analyst will work closely with internal teams and external platforms to maintain financial accuracy and operational efficiency across all 15 IDREs

Essential Job Duties and Responsibilities:

• Organize and maintain reports into a format that can easily be evaluated by Leadership and external parties.
• Perform daily reconciliation of outstanding refunds across all 15 IDREs to ensure timely and accurate identification of overpayments.
• Analyze payer remittances and IDR settlement data to validate refund eligibility.
• Process refund transactions accurately and in compliance with internal controls, payer contracts, and regulatory requirements.
• Coordinate with Refund Team Leads and Accounting to resolve discrepancies and ensure proper posting and documentation.
• Maintain organized and up-to-date records of all refund activities for audit readiness.
• Identify and escalate any discrepancies or issues requiring further investigation.
• Assist in month-end reporting and support internal audits related to IDR refund activities.
• Collaborate with internal stakeholders to ensure smooth resolution of open refund items.
• Strong organizational, analytical, and problem-solving skills
• Knowledge of the Arbitration Process
• Proactively assess and implement improvements to the refund handling process
• Professionalism in all dealings, both internal and external customers
• Ability to clearly communicate, both verbally and in writing
• Other duties as assigned

Education and/or Experience:

• College degree or equivalent work experience required
• Reconciliation Experience preferred
• Minimum of 1 year’s refund experience
• IDR or Healthcare experience preferred
• Leadership experience preferred

Skills/Specialized Knowledge:

• Strong organizational analytical and problem-solving skills
• Knowledge of Refunds processing and collections
• Knowledge of independent dispute resolution process
• Ability to clearly communicate both verbally and in writing
• Proficiency in Microsoft Excel and comfort with data analysis and reconciliation tools.
• Knowledge of laws that regulates communication and privacy act.

Other Requirements:

• Must maintain professional appearance
• Ability to be at work at regular and consistent times