[Hiring] Medical Claims Billing Specialist @Privia Health

Role Description

Under the direction of the Associate Director of Revenue Cycle Management, the Accounts Receivable (AR) Manager is responsible for ensuring the accurate and timely processing of all assigned claims. This role includes:

• Promptly addressing daily correspondence from physician practices.
• Reviewing and appealing insurance claim denials.
• Following up on aged claims.
• Taking necessary steps to resolve all claim issues or questions that escalate to the RCM team, including Salesforce case management.

Primary Job Duties:

• Management of the accounts receivable (AR), including analysis of the aged AR and suggesting billed rules/edits to prevent errors.
• Denial management: investigate denial sources, resolve and appeal denials, which may include contacting payer representatives.
• Make independent decisions regarding claim adjustments, resubmission, appeals, and other claim resolution techniques.
• Collaborate with internal teams (Performance, Operations, Sales) and care center staff when appropriate.
• Support large care center go-lives when applicable, which may include overnight travel.
• Work closely with the Revenue Optimization team to ensure reimbursement aligns with payer contract agreements, performing denial analysis utilizing the Trizetto platform.
• Work directly with practice consultants or physicians to ensure optimal revenue cycle functionality.
• Drive toward achievement of department’s daily and monthly Key Performance Indicators (KPIs).
• Other duties as assigned.

Qualifications

• High School Graduate.
• 3+ years experience in a 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.
• Advanced Microsoft Excel skills (e.g., pivot tables, VLOOKUP, sort/filtering, formulas) preferred.
• Experience with athenaHealth and/or athenaOne required.
• Orthopedic medical claims billing experience preferred.
• Experience with California payers and portals preferred.
• Must comply with HIPAA rules and regulations.

Requirements

• The hourly range for this role is $24/hr to $26.45/hr in hourly base pay, exclusive of any bonuses or benefits.
• 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

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

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.