Insurance Credit Resolution Specialist (Hybrid)
Core
Process insurance-related credits, refunds, and account reconciliations for physician practices to ensure compliance and accuracy.
Role type
Insurance Credit Resolution Specialist
Builds
Refund checks and credit adjustments for physician practices
Domain
Healthcare revenue cycle management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Insurance claims processing, account reconciliation, Explanation of Benefits (EOB) analysis, HIPAA compliance, payer guideline adherence, refund transaction management, Salesforce usage
Preferred skills
AthenaOne EMR experience, physician revenue cycle background
Responsibilities
Review patient accounts with insurance overpayments, reconcile account balances by applying or refunding credits, analyze EOBs and insurance payments to verify credits, process refunds for insurance companies, prepare and submit refund requests per payer workflows, resolve outstanding credits or discrepancies with internal teams and external parties, maintain detailed records for auditing, respond to inquiries regarding refunds
Seniority
Mid-level, hands-on IC