The Refund Collection Analyst provides day-to-day operational support and leadership within RCM Refunds and Billing, with responsibility for patient and insurance refund workflows and account reconciliation activities. The role supports process standardization, identifies and resolves complex refund and reconciliation issues, guides team members, and serves as an escalation point for refund, billing, and reconciliation matters.
Essential Job Functions:
- 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
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
