Insurance Refunds & Claims Specialist

Job Description

This role requires hybrid work in our Arlington, VA office

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.  

• 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 work independently to meet productivity expectations
• Use Salesforce to manage worklists and requests/inquiries from Care Centers

Qualifications

• Education: 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
• AthenaOne EMR experience preferred
• Must comply with HIPAA rules and regulations

The hourly range for this role is $25.00-$26.45 in base pay and exclusive of any bonuses or benefits  (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 10%. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

Additional Information

All your information will be kept confidential according to EEO guidelines.

Technical Requirements (for remote workers only, not applicable for onsite/in office work):

In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like https://www.speedtest.net/. This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.

Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. We understand that healthcare is local and we are better when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age, color, national origin, physical or mental (dis)ability, race, religion, gender, sex, gender identity and/or expression, marital status, veteran status, or any other characteristic protected by federal, state or local law.