[Hiring] Medical Claims Billing & Case Management Specialist @Privia Health

Role Description

The Sr. AR & Case Management Specialist (Sr. AR Manager) is responsible for complete, accurate and timely processing of all designated claims, reviewing and responding to daily correspondence from physician practices in a timely manner, answering incoming SalesForce cases and providing information as requested or properly authorized. The Senior AR Manager will take steps necessary to resolve all claim issues or questions that escalate to the RCM team.

• Resolution of SalesForce cases and management of issues and the team resolving the cases is a key element in this role.
• Overseeing functions within Accounts Receivable in accordance with compliant best practices, such as Claims Worklists, Zero Pay, Unapplied, and Denials.
• Management of the accounts receivable (AR) including analysis of the aged AR, looking for root cause issues; writing rules where appropriate to stop errors from occurring.
• Denial management - investigating denial sources, resolving and appealing denials which may include contacting payer representatives.
• Makes independent decisions regarding claim adjustments, resubmission, appeals, and other claim resolution techniques.
• Serves as an escalation point, and escalates issues to the appropriate party.
• Suggest and run point on policy updates as needed.
• Work directly with practice consultants and/or physicians via Salesforce to ensure optimal revenue cycle functionality.
• Focused on driving toward achievement of department’s daily and monthly Key Performance Indicators (KPIs), requiring a team focused approach to attainment of these goals.
• Other duties as assigned.

Qualifications

• High School Graduate.
• 5+ years experience in a physician medical billing office or equivalent claims experience.
• Must understand the drivers of revenue cycle optimal performance and be able to investigate and resolve complex claims.
• Microsoft Excel skills (ex: pivot tables, VLOOKUP, sort/filtering, formulas) preferred.
• Experience working with athenaOne suite of tools preferred.
• Experience using Salesforce for case management preferred.
• Must provide accessibility to private, quiet work space with high-speed internet to effectively work remotely (if a remote worker).
• Experience with VA payers & providers preferred.
• Must comply with HIPAA rules and regulations.
• Excellent written and verbal communication.

Requirements

• The hourly range for this role is $23/hr to $25/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.

Benefits

• All your information will be kept confidential according to EEO guidelines.
• Employees who regularly work from home offices are eligible for expense reimbursement to offset internet costs.

Technical Requirements

• 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 speedtest.net .
• Work with your internet provider if you have questions about your connection.