Full-Time Insurance Credit Resolution Specialist

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.

This role requires expertise in reviewing and analyzing patient accounts to identify insurance overpayments and processing refund requests in accordance with regulatory and organizational policies.

The ideal candidate will have a strong understanding of health insurance processes, attention to detail, and the ability to work with various stakeholders, including insurance companies, healthcare providers, and patients.

Primary Job Duties:

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

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

Requirements:

• High School Graduate, Medical Office training certificate or relevant experience
• 5+ years experience in physician revenue cycle / claims management
• Prior experience working with Arizona-based payors is highly desirable.
• Background with posting charges, claim follow up, collections, and payment posting, benefits eligibility.
• Experience with AthenaHealth and/or AthenaOne a plus
• Must comply with HIPAA rules and regulations

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