Top 2 Insurance Claims and Policy Processing Clerks Jobs in Houston, TX

Medical Insurance Refund Clerk (Revenue Cycle)
Gryphon Healthcare —Houston, TX
- Customer service
- HIPAA
- Research
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Medical Insurance Refund Clerk (Revenue Cycle)

Gryphon Healthcare -
Houston, TX

Quick Apply

Job Details

Qualifications

Customer communication
Medicare
Spreadsheets
High school diploma or GED
Health insurance knowledge
Medicare regulations
Data interpretation
Centers for Medicare & Medicaid Services (CMS) billing regulations
Medical explanation of benefits reviews
Medicaid regulations
Medicaid
Productivity software

Full Job Description

Job Title: Medical Insurance Refund Clerk (Revenue Cycle)

Position Summary

The Medical Insurance Refund Clerk plays a critical role within the Revenue Cycle team by identifying, researching, and processing insurance and patient overpayments. This position ensures accurate and timely refund processing while maintaining compliance with payer guidelines, regulatory requirements, and company policies.

This role requires strong attention to detail, analytical thinking, and a commitment to financial accuracy, helping ensure integrity across the revenue cycle.

Key Responsibilities

Review insurance claims, EOBs/ERAs, and payment postings to identify overpayments and refund opportunities
Research and validate refund requests, including coordination with AR, billing, and cash posting teams
Process refunds to insurance carriers, patients, and third parties accurately and within required timelines
Verify claim adjustments, recoupments, and payment discrepancies prior to refund issuance
Maintain complete and accurate documentation of all refund activity
Communicate with payers, clients, and internal departments regarding refund status and resolution
Investigate and resolve discrepancies, including duplicate payments and credit balances
Reconcile refund-related accounts and assist with month-end close processes
Ensure compliance with payer contracts, CMS guidelines, and applicable state/federal regulations
Prepare and track reports on refunds, adjustments, and outstanding credit balances
Support internal and external audits by providing required documentation

Required Qualifications

High school diploma or equivalent required
1–3 years of experience in medical billing, insurance claims, revenue cycle, or healthcare accounting
Working knowledge of insurance reimbursement, EOB/ERA interpretation, and overpayment workflows
Familiarity with payer guidelines (commercial, Medicare, Medicaid)
Proficiency in Microsoft Office, particularly Excel
Experience with practice management systems, clearinghouses, or billing software
Strong attention to detail with a high level of accuracy
Solid analytical and problem-solving skills

Preferred Qualifications

Experience in high-volume RCM or third-party billing environment
Knowledge of both in and out-of-network reimbursement and payer recoupment trends
Exposure to refund audits and compliance processes

Key Skills & Competencies

Strong numerical accuracy and data entry skills
Excellent organization and time management
Professional written and verbal communication
Ability to handle confidential financial and patient information (HIPAA compliance)
Customer service mindset with internal and external stakeholders
Ability to work both independently and collaboratively in a fast-paced environment

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Insurance Claims and Policy Processing Clerks jobs in Houston, TX

Medical Insurance Refund Clerk (Revenue Cycle)

Warranty Administrator I

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