Insurance Credit Resolution Specialist (Hybrid)

Privia Health•Arlington, VA

7d•$25 - $26•Hybrid

About The Position

Privia Health™ is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers Under the direction of the Sr. Manager, Revenue Cycle Management, the Insurance Credit Resolution Specialist is responsible for complete, accurate and timely processing of all assigned insurance related credits. Processing of these credits includes reviewing and responding to daily correspondence from physician practices in a timely manner, answering incoming inquiries, preparing insurance refund checks for mailing, and processing returned checks.

Requirements

Education: High School Graduate, Medical Office training certificate or relevant experience
Must be familiar with Arizona Medicaid (AHCCCS) and Arizona Medicare.
3+ years experience in physician revenue cycle / claims management
Background with posting charges, claim follow up, collections, and payment posting
Must have experience working with athenahealth’s suite of tools
Must comply with HIPAA rules and regulations

Nice To Haves

Experience with AZ Payers preferred.

Responsibilities

Identify and review patient accounts with insurance overpayments, ensuring accuracy and compliance with payer guidelines
Reconcile account balances by applying, transferring, or refunding credits where necessary
Analyze explanation of benefits (EOBs) and insurance payments to verify credits and resolve discrepancies
Process refunds for insurance companies in a timely and accurate manner
Prepare and submit refund requests according to established policies and procedures, to include payer specific workflows
Ensure proper documentation and communication regarding refund transactions with all relevant parties
Resolve any outstanding credits or account discrepancies by working with insurance companies, patients, and internal teams
Ensure all refund and credit transactions are conducted in compliance with healthcare regulations, including HIPAA and payer-specific guidelines.
Maintain detailed records of all credit and refund activities for auditing and reporting purposes.
Respond to inquiries regarding refunds, and resolve issues in a timely and customer-focused manner.
Be able to meet productivity expectations
Use Salesforce to manage worklists and requests/inquiries from Care Centers