Insurance Credit Resolution Specialist

As an Insurance Credit Resolution Specialist at Privia Health, you'll be tasked with processing and managing insurance credits effectively. Your responsibilities include reviewing daily correspondence, responding to inquiries from physician practices, preparing insurance refund checks, processing returned checks, and utilizing athenaNet to track and resolve claims. You will also implement specific workflows for various refund processes and manage worklists through Salesforce.

To qualify for the Insurance Credit Resolution Specialist position at Privia Health, you should have a high school diploma and a medical office training certificate or relevant work experience. Additionally, a minimum of three years of experience in physician revenue cycle and claims management is required. Familiarity with athenahealth's suite of tools and a commitment to HIPAA compliance are also essential.

At Privia Health, you can expect a hybrid work environment for the Insurance Credit Resolution Specialist role, allowing flexibility between working remotely and in our Arlington office. We foster a collaborative and inclusive work culture where employees are encouraged to bring their whole selves to work, reflecting our diverse communities.

The salary range for the Insurance Credit Resolution Specialist role at Privia Health is between $50,000.00 and $55,000.00, not including potential bonuses or benefits. The offered salary is determined based on factors such as relevant experience, education, and geographic location, ensuring fair compensation for your expertise.

Privia Health is committed to employee development, offering various resources and programs for continuous learning. As an Insurance Credit Resolution Specialist, you will have access to training and support designed to enhance your skills in revenue cycle management and claims processing, helping you grow within the organization.

Absolutely! In my previous role, I managed various aspects of revenue cycle management, particularly focusing on processing insurance credits. I am skilled in analyzing overpaid claims and ensuring accurate refunds, leveraging software like athenaNet to track my progress. I believe my experience aligns well with the requirements for the Insurance Credit Resolution Specialist position.

When faced with processing multiple insurance refunds, I prioritize tasks based on urgency and complexity. I assess due dates and the potential impact on our operations, ensuring that I maintain consistency and accuracy in handling requests. Utilizing organizational tools has been beneficial in managing my workload efficiently.

To effectively resolve denied claims, I first conduct a thorough review of all claim details to identify the reason for denial. I then communicate with the appropriate parties, whether that be the physician office or insurance companies, to gather the necessary information for appeal. Additionally, I keep meticulous records to track progress and ensure prompt follow-ups, fostering better relationships with stakeholders.

One challenging situation I encountered was reconciling discrepancies in payment postings that led to significant delays in revenue. I took the initiative to analyze patterns in the discrepancies and developed a checklist to streamline the process moving forward. This proactive approach not only resolved the immediate issue but also improved our accuracy and efficiency in future postings.

Ensuring HIPAA compliance is a top priority for me when handling sensitive information. I always adhere to the established protocols for data privacy and confidentiality, including limiting access to sensitive data to authorized personnel only. Additionally, I stay updated on HIPAA regulations and participate in training sessions to reinforce best practices.

In my previous roles, I’ve extensively used athenaNet for claims management and insurance credit resolution, which has helped streamline processes, track requests, and manage worklists effectively. I am also proficient in utilizing Salesforce to keep track of inquiries and follow-ups, ensuring a smooth resolution process.

Handling stress under tight deadlines is crucial in this role. I find that maintaining an organized schedule and breaking tasks into manageable parts helps alleviate pressure. Additionally, I practice effective communication with my team to ensure we align our efforts when deadlines are approaching, thereby minimizing last-minute challenges.

In my last position, I noticed that our process for dealing with returned checks was slow and led to delays. I proposed a revised workflow that established clear guidelines and timelines for each stage of the check processing. After implementation, we reduced the time to resolve returned checks by over 30%, which significantly improved our department's efficiency.

I am motivated by the prospect of making a tangible impact on patients' healthcare experiences. Working in revenue cycle management allows me to directly support healthcare providers while ensuring they receive timely payments, which in turn enables them to focus on delivering quality care. The intersection of healthcare and technology in this role is particularly appealing to me.

I believe that strong analytical skills, attention to detail, and effective communication are essential qualities for an Insurance Credit Resolution Specialist. Additionally, having a proactive approach to problem-solving and adaptability to changing regulations and processes are crucial for success in this position.