UCSD Layoff from Career Appointment: Apply by 06/03/26 for consideration with preference for rehire. All layoff applicants should contact their Employment Advisor.
Reassignment Applicants: Eligible Reassignment clients should contact their Disability Counselor for assistance.
Candidates hired into this position may have the ability to work remotely.
UC San Diego Health's Revenue Cycle department supports the organization’s mission to deliver outstanding patient care and create a healthier world — one life at a time. We are a diverse, patient-focused, high-performing team committed to quality, collaboration, compliance, and continuous improvement. We offer challenging career opportunities in a fast-paced and innovative environment and welcome individuals who demonstrate strong problem-solving skills, accountability, accuracy, and customer service.
The Credit Refund Specialist is responsible for researching, validating, and resolving hospital credit balance accounts, insurance refund requests, overpayments, payer recoupments, and related account adjustments. This position requires strong hospital/facility billing knowledge, critical thinking, attention to detail, and the ability to determine whether a refund is appropriate based on claim history, payment activity, payer correspondence, contract terms, adjustment activity, and applicable state and federal requirements.
This role supports accurate reimbursement, appropriate account resolution, compliance with refund processing standards, and timely communication with payers and internal departments. The position requires sound judgment to identify unsupported or unclear refund requests, escalate complex accounts when needed, and ensure refunds are processed accurately and compliantly.
Key Responsibilities:
-
Analyze hospital insurance credit balance accounts to ensure timely identification, validation, resolution, and issuance of accurate refunds when appropriate.
-
Review insurance refund requests, payer correspondence, remittance activity, claim history, adjustments, and payment activity to determine whether a refund is supported.
-
Review and interpret hospital payer contracts and reimbursement methodologies to verify expected reimbursement and identify discrepancies such as overpayments, underpayments, duplicate payments, or incorrect payer calculations.
-
Research and resolve account credit balances related to coordination of benefits, retroactive eligibility changes, payer recoupments, duplicate payments, contract adjustments, payment posting discrepancies, and billing corrections.
-
Respond professionally and effectively to inquiries from payers and internal departments regarding account balances, refund statuses, payment activity, and account resolution.
-
Process insurance refund requests accurately and compliantly according to payer requirements, organizational standards, and applicable state and federal regulations.
-
Identify, analyze, and resolve billing discrepancies, claim errors, payment variances, and account issues related to credit balances and refunds.
-
Collaborate with internal teams, including billing, denials, payment posting, revenue integrity, contracting, coding, and patient access, to support accurate reimbursement and account reconciliation.
-
Maintain clear, accurate, and compliant account documentation supporting refund decisions, account actions, and escalation outcomes.
-
Maintain compliance with HIPAA regulations and ensure confidentiality and security of patient information throughout the refund and credit balance process.
Three (3) years of acute care hospital billing, collections, payer follow-up, credit balance, refund, or account resolution experience.
State and Federal rules and regulations related to facility medical insurance billing, claim processing, and refund handling.
Demonstrated knowledge reviewing and resolving hospital claim errors, payment discrepancies, account balances, and payer correspondence.
Thorough knowledge of UB04 and revenue codes as it pertains to hospital billing and reimbursement.
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.
Strong written and verbal communication skills, including the ability to document account activity clearly, accurately, and professionally.
Demonstrated ability to manage high-volume account work while maintaining accuracy, productivity, compliance, and attention to detail.
Recent hospital/facility credit balance and insurance refund processing experience.
Recent Epic Resolute Hospital Billing experience.
Experience researching and validating payer refund requests, overpayments, duplicate payments, coordination of benefits issues, retroactive eligibility changes, recoupments, underpayments, and payment discrepancies.
Strong UB-04/CMS-1450 knowledge, including bill type, revenue codes, condition codes, occurrence codes, value codes, HCPCS/CPT codes, modifiers, diagnosis codes, and payer-specific facility billing requirements.
Understanding of the relationship between revenue codes, HCPCS/CPT codes, payer reimbursement, payment posting, adjustment activity, and account credit balances.
Experience reviewing remittance advice, payer correspondence, EOBs, claim status responses, refund letters, and account documentation to determine appropriate next steps.
Critical thinking skills with the ability to determine whether a refund is supported, whether additional research is needed, or whether the account requires escalation.
Experience identifying refund trends, payer calculation concerns, payment discrepancies, or process issues that may require internal review or payer follow-up.
Familiarity with payer portals, document imaging systems, clearinghouse tools, claim status research tools, and account documentation workflows.
Experience collaborating with billing, denials, payment posting, revenue integrity, contracting, coding, patient access, or payer representatives to resolve complex account balances.
Understanding of hospital reimbursement concepts such as DRG, per diem, case rate, percent of charges, carve-outs, bundled services, and payer contract/payment methodology basics.
Pay Transparency Act
Annual Full Pay Range: $61,116 - $75,982 (will be prorated if the appointment percentage is less than 100%)
Hourly Equivalent: $29.27 - $36.39
Factors in determining the appropriate compensation for a role include experience, skills, knowledge, abilities, education, licensure and certifications, and other business and organizational needs. The Hiring Pay Scale referenced in the job posting is the budgeted salary or hourly range that the University reasonably expects to pay for this position. The Annual Full Pay Range may be broader than what the University anticipates to pay for this position, based on internal equity, budget, and collective bargaining agreements (when applicable).
If employed by the University of California, you will be required to comply with our Policy on Vaccination Programs, which may be amended or revised from time to time. Federal, state, or local public health directives may impose additional requirements.
If applicable, life-support certifications (BLS, NRP, ACLS, etc.) must include hands-on practice and in-person skills assessment; online-only certification is not acceptable.
UC San Diego Health is the only academic health system in the San Diego region, providing leading-edge care in patient care, biomedical research, education, and community service. Our facilities include two university hospitals, a National Cancer Institute-designated Comprehensive Cancer Center, Shiley Eye Institute, Sulpizio Cardiovascular Center, the only Burn Center in the county, and dozens of outpatient clinics. We invite you to join our team!
Applications/Resumes are accepted for current job openings only. For full consideration on any job, applications must be received prior to the initial closing date. If a job has an extended deadline, applications/resumes will be considered during the extension period; however, a job may be filled before the extended date is reached.
To foster the best possible working and learning environment, UC San Diego strives to cultivate a rich and diverse environment, inclusive and supportive of all students, faculty, staff and visitors. For more information, please visit UC San Diego Principles of Community.
The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected status under state or federal law.
For the University of California’s Anti-Discrimination Policy, please visit: https://policy.ucop.edu/doc/1001004/Anti-Discrimination
UC San Diego is a smoke and tobacco free environment. Please visit smokefree.ucsd.edu for more information.
UC San Diego Health maintains a marijuana and drug free environment. Employees may be subject to drug screening.
Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts an offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; or have filed an appeal of a finding of substantiated misconduct with a previous employer.
a. "Misconduct" means any violation of the policies governing employee conduct at the applicant’s previous place of employment, including, but not limited to, violations of policies prohibiting sexual harassment, sexual assault, or other forms of harassment, or discrimination, as defined by the employer. For reference, below are UC’s policies addressing some forms of misconduct:
- UC Sexual Violence and Sexual Harassment Policy
-
UC Anti-Discrimination Policy
-
Abusive Conduct in the Workplace
