Insurance Credit Resolution Specialist (Hybrid)

About the role

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. This role requires hybrid work in our Arlington, VA office.

Responsibilities

• Reviewing and responding to daily correspondence from physician practices in a timely manner
• Answering incoming inquiries
• Preparing insurance refund checks for mailing
• Processing returned checks
• Identifying and reviewing patient accounts with insurance overpayments, ensuring accuracy and compliance with payer guidelines
• Reconciling account balances by applying, transferring, or refunding credits where necessary
• Analyzing explanation of benefits (EOBs) and insurance payments to verify credits and resolve discrepancies
• Processing refunds for insurance companies in a timely and accurate manner
• Preparing and submitting refund requests according to established policies and procedures, to include payer‑specific workflows
• Ensuring proper documentation and communication regarding refund transactions with all relevant parties
• Resolving any outstanding credits or account discrepancies by working with insurance companies, patients, and internal teams
• Ensuring all refund and credit transactions are conducted in compliance with healthcare regulations, including HIPAA and payer‑specific guidelines
• Maintaining detailed records of all credit and refund activities for auditing and reporting purposes
• Responding to inquiries regarding refunds, and resolving issues in a timely and customer‑focused manner
• Being able to work independently to meet productivity expectations
• Using 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

Benefits

• Medical, dental, vision, life, and pet insurance
• 401K
• Paid time off
• Other wellness programs

Pay

• Hourly range: $25.00‑$26.45 base pay
• Exclusive of any bonuses or benefits
• Annual bonus targeted at 10%
• Base pay determined based on relevant factors such as experience, education, and geographic location