Job Description

The Lead Payments and Refunds Specialist is responsible for overseeing the daily operations of payment posting and refund processing activities across all divisions. This role serves as the subject matter expert for payment reconciliation, patient credit balances, and refund management while providing guidance, training, and support to Payments and Refund Specialists. The Lead works closely with the RCM Director to ensure accuracy, compliance, process improvement, and achievement of departmental goals.

Essential Functions

• Serve as the primary resource and mentor for the Payments and Refunds team.
• Provide training and onboarding for new staff members.
• Monitor work queues and productivity to ensure timely posting and refund processing.
• Review team performance and provide feedback to support quality and efficiency improvements.
• Assist with developing and maintaining departmental policies and procedures.
• Escalate complex payment, reconciliation, or refund issues to the RCM Director as appropriate.
• Support cross-functional collaboration with Billing, Follow-Up, Credentialing, and Front Office teams.

Education and/or experience

• High school diploma or equivalent required; Associate's or Bachelor's degree preferred.
• Minimum 5 years of experience in medical billing, payment posting, or revenue cycle operations.
• Minimum 1-2 years of lead, supervisory, or mentoring experience preferred.
• Strong knowledge of medical insurance plans including Medicare, Medicaid, Tricare, and commercial payers.
• Comprehensive understanding of ERA/EOB processing, payment reconciliation, and refund management.
• Familiarity with CPT, ICD-10, and medical billing regulations.
• Experience with practice management systems, EHR platforms, and clearinghouses.
• Advanced proficiency with Microsoft Excel, including reporting and data analysis.
• Strong analytical, organizational, and problem-solving skills.
• Excellent written and verbal communication skills.
• Ability to manage multiple priorities while maintaining a high level of accuracy.

Total Rewards
The referenced base salary range represents the low and high end of Chesapeake Specialty Care salary range for this position.Some candidates will not be eligible for the upper end of the salary range. Exact salary will ultimately depend on multiple factors, which may include the successful candidate's geographic location, skills, work experience, market conditions, internal equity, responsibility factor and span of control, education/training and other qualifications.