Patient Refunds Specialist

Company Description

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.

Job Description

Under the direction of the Manager, Patient Finance & Collections, the Patient Finance Specialist is
responsible for reviewing, managing and processing patient refund requests while ensuring compliance
with company policies and healthcare regulations. This role involves reviewing patient accounts for
overpayments, reconciling balances, and issuing refunds in a timely and accurate manner. The Patient
Finance Specialist will service as the primary point of contact for refund resolution and will be responsible
for SalesForce case management. The ideal candidate will have strong attention to detail, excellent
communication skills, and experience in medical billing or accounts receivable.

Primary Job Duties:

• Responsible for managing the patient refund and credits workflows, reviewing, approving and processing patient refunds
• Serve as the subject matter expert and point of escalation for patient credit SalesForce cases
• Reconcile patient accounts to ensure correct application of payments and adjustments
• Investigate and resolve any account discrepancies that may impact refunds, including coordination with insurance companies when needed
• Bring complex refund issues to a resolve
• Respond to inquiries and close patient inquiries in a timely manner
• Maintain detailed documentation of refund activities for auditing and reporting purposes
• Communicate with patients regarding refunds, providing clear explanations of overpayments and the refund process when applicable
• Coach staff members on proper patient refund procedures
• Enforce internal policies, procedures and controls to ensure patient confidentiality and security
• Partner with Customer Service, Operations Consultants and RCM Teams to improve efficiency and processes related to patient billing and refunds
• Perform projects on an ad-hoc basis
• Other duties as assigned

Qualifications

• High School Degree or equivalent preferred
• 2+ years of experience in medical billing office or equivalent claims experience
• 2+ years of experience in a customer facing role preferred
• 1 year of experience with athenaHealth and/or athena One
• Advanced Microsoft Excel skills (ex: pivot tables, VLOOKUP, sort/filtering, formulas)
• Hands-on experience with patient billing and refunds

The hourly range for this role is $24/hr to $26.45/hr in hourly base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 10%. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

Additional Information

All of your information will be kept confidential according to EEO guidelines.

Technical Requirements (for remote workers only, not applicable for onsite/in office work):

In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.

Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. We understand that healthcare is local and we are better when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age, color, national origin, physical or mental (dis)ability, race, religion, gender, sex, gender identity and/or expression, marital status, veteran status, or any other characteristic protected by federal, state or local law.

Department: Revenue Cycle