Credit / Refund Rep - Hybrid - 134970

The title, description and qualifications of this posting have been updated as of 08/13/25.

UC San Diego Health's Revenue Cycle department supports the organization's mission to deliver outstanding patient care and to create a healthier world - one life at a time. We are a diverse, patient-focused, high-performing team with a commitment to quality, collaboration, and continuous improvement that enables us to deliver the maximum standard of care to our patients. We offer challenging career opportunities in a fast-paced and innovative environment and we embrace individuals who demonstrate a deep passion for problem-solving and customer service.

The Credit/ Refund Rep (Patient Biller III) is responsible for the comprehensive processing of hospital credit balance accounts, insurance refunds, and related adjustments. This position addresses inquiries from patients, insurance companies, and internal departmental teams, identifying and resolving credit balances, analyzing account adjustments, and ensuring compliance with refund processing standards, including adherence to California state and federal regulations governing refunds.

Key Responsibilities:

• Analyze hospital insurance credit balance accounts, ensuring timely identification, resolution, and issuance of accurate refunds.
• Review and interpret hospital payer contracts to verify expected reimbursement, identify discrepancies such as underpayments or overpayments, and manage related adjustments.
• Respond professionally and effectively to inquiries from payers, and internal departments regarding account balances and refund statuses.
• Process insurance refund requests accurately and compliantly according to payer requirements, California state, and federal regulations.
• Identify, analyze, and resolve billing edits, discrepancies, and denials related to credit balances and refunds.
• Collaborate proactively with internal teams to support accurate revenue recognition, account reconciliation, and timely communication of account adjustments.
• Maintain compliance with HIPAA regulations, ensuring confidentiality and security of patient information throughout the refund and credit balance process.

• Three (3) years of recent acute care hospital billing and collection experience especially credit/refund experience.

• State and Federal rules and regulations related to billing facility medical insurance Claims.

• Demonstrated knowledge reviewing/processing hospital claim errors.

• Thorough knowledge of UB04 and revenue codes as it pertains to hospital billing.

• Extensive knowledge in submission of hospital claims appeals and basic knowledge in medical terminology, ICD9, CPT, HCPCS coding principles.

• Demonstrated knowledge of facility reimbursement contracts and reimbursement methodologies including but not limited to per diem, fee schedule, case rate and DRG's.

• Demonstrated knowledge reviewing/processing facility insurance refund requests and account credit balances.

• Epic Resolute experience.

• UB04 experience.

• Previous hospital billing experience.

• Previous hospital credit balance/refund processing experience.

• Must be able to work various hours and locations based on business needs.

• Employment is subject to a criminal background check and pre-employment physical.