Insurance Credit Resolution Specialist (Hybrid)

As an Insurance Credit Resolution Specialist at Privia Health, you'll be responsible for the timely and accurate processing of insurance-related credits. This includes managing daily correspondence from physician practices, answering inquiries, and preparing insurance refund checks. Additionally, you'll research and resolve overpaid and denied claims using athenaNet and Salesforce, ensuring a smooth workflow within our revenue cycle management process.

To qualify for the Insurance Credit Resolution Specialist position at Privia Health, candidates should have a high school diploma and at least 3 years of experience in physician revenue cycle or claims management. Familiarity with athenahealth's suite of tools is essential, along with knowledge of charge posting, claim follow-up, and payment posting. A medical office training certificate is a plus and understanding HIPAA compliance is a requirement.

Privia Health is committed to the professional growth of its Insurance Credit Resolution Specialists. We provide on-the-job training with access to leading industry tools like Salesforce and athenaNet, while also fostering an inclusive work environment that values diverse perspectives. Employees are encouraged to pursue continuous learning opportunities to enhance their skills and stay updated in the ever-evolving healthcare landscape.

The work environment for an Insurance Credit Resolution Specialist at Privia Health is hybrid, allowing you to work both in-office at our Arlington, VA headquarters and remotely. This setup fosters collaboration with your team while ensuring you have the flexibility to manage your work effectively. Our office culture promotes open communication, teamwork, and a strong commitment to enhancing patient experiences.

The hourly pay range for the Insurance Credit Resolution Specialist role at Privia Health is between $25.00 and $26.45, which is exclusive of any annual bonuses or benefits. The specific pay is determined based on your relevant experience and education, as well as your geographic location. Additionally, this position is eligible for an annual bonus targeted at 10%.

When answering this question, highlight specific functionalities of athenahealth that you've used, such as processing claims or managing patient data. Share examples of how you've resolved issues or improved efficiency using this software. Be concise and focus on how your experience aligns with the requirements of the Insurance Credit Resolution Specialist role.

In your response, explain the process you follow to identify the root causes of denied claims. Discuss researching claim details, communicating with insurance companies for clarifications, and working with the healthcare team to provide any necessary documentation. Stress the importance of thoroughness and follow-up in ensuring timely resolution and payment.

When addressing this question, focus on your understanding of HIPAA guidelines and share specific actions you take to maintain patient confidentiality, such as securing data and limiting access to sensitive information. Highlight any prior experience ensuring compliance in past roles, emphasizing your commitment to protecting patient rights and adhering to regulations.

Discuss how you prioritize tasks based on urgency and importance and any tools or techniques you use to stay organized. Mention your experience handling high-volume work, such as processing 35+ insurance refunds a day, and stress your adaptability in managing unexpected challenges while meeting deadlines.

Describe a challenging interaction you had, focusing on your approach to resolving conflicts or misunderstandings. Detail how you listened to their concerns, clarified any issues, and worked collaboratively to achieve a mutually beneficial outcome. This showcases your customer service skills and ability to maintain professional relationships.

Share your passion for enhancing the healthcare experience at both the provider and patient levels. Discuss how your previous experiences in claims management have shaped your interest in streamlining processes and ensuring that practices receive timely payments. Conveying your commitment to quality care can resonate well with the hiring team.

Indicate your proactive approach to continuous learning. You might mention resources you regularly review, like industry publications, professional organizations, or webinars focused on revenue cycle management and healthcare policy. Emphasizing your dedication to understanding changes in the field demonstrates your commitment to excellence in your role.

Talk about how you effectively use software, like Salesforce, to track and respond to inquiries from care centers. Share any specific features that help manage workflows and prioritize tasks, enhancing communication with multiple stakeholders to improve overall efficiency in your daily activities.

Provide a detailed outline of your experience preparing insurance refunds, including any specific processes you have followed in previous roles. Discuss your attention to detail in ensuring accuracy and compliance, as well as any methodologies you adopt to minimize errors, reflecting your understanding of the significance of these tasks in the revenue cycle.

Discuss your systematic approach to identifying, verifying, and resolving overpayments. Share any specific strategies you employ, such as confirming the overpayment with insurance companies and communicating with affected physicians. This not only shows your expertise but also your understanding of its importance in maintaining financial integrity within the practice.