Insurance Credit Resolution Specialist (Hybrid)

Privia Health•Arlington, VA

9d•Hybrid

About The Position

Privia Health is seeking an Insurance Credit Resolution Specialist to join their team. This role is responsible for the complete, accurate, and timely processing of all assigned insurance-related credits. The specialist will review and respond to daily correspondence from physician practices, answer incoming inquiries, prepare insurance refund checks for mailing, and process returned checks. The role involves identifying and reviewing patient accounts with insurance overpayments, reconciling account balances, analyzing explanations of benefits (EOBs) and insurance payments to verify credits and resolve discrepancies, and processing refunds for insurance companies. The specialist must ensure compliance with healthcare regulations, maintain detailed records, and respond to inquiries in a timely and customer-focused manner. This is a hybrid role requiring work in the Arlington, VA office.

Requirements

High School Graduate, Medical Office training certificate or relevant experience
3+ years experience in physician revenue cycle / claims management
Background with posting charges, claim follow up, collections, and payment posting
Must comply with HIPAA rules and regulations

Nice To Haves

AthenaOne EMR experience preferred

Responsibilities

Review and respond to daily correspondence from physician practices in a timely manner.
Answer incoming inquiries.
Prepare insurance refund checks for mailing.
Process returned checks.
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.
Work independently to meet productivity expectations.
Use Salesforce to manage worklists and requests/inquiries from Care Centers.