Medical Credit Resolution Specialist

Company Description

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

Job Description

This role is hybrid, working in the Arlington, VA office 1-2 days/week

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.  

• Implement payer specific workflows for void requests, take back requests and insurance refund initiations
• Research and resolve overpaid and denied claims in athenaNet
• Use Salesforce to manage worklists and requests/inquiries from Care Centers
• Successfully process 35+ insurance refunds daily
  In office specific duties:
• Utilize athenaNet software to identify and print appropriate insurance refund letters
• Enter insurance refund check #s into athenaNet for tracking 
• In the absence of a payer refund letter, use letter template to make custom refund letters 
• Prepare checks to be mailed including matching checks with refund letter, folding, inserting, addressing and sealing envelopes 
• Sorting checks by payer
• Retrieve and process returned checks accordingly 
• Other duties as needed

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
• Must have experience working with athenahealth’s suite of tools
• Must comply with HIPAA rules and regulations

The salary range for this role is $50,000.00-$55,000.00 in base pay and exclusive of any bonuses or benefits. 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. Privia is a better company 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.