Revenue Integrity 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 Sr. Manager, Revenue Integrity and/or Sr. Manager, Revenue Optimization the Revenue Integrity Specialist is responsible for complete, accurate and timely processing of reimbursement/payment audits in compliance with Privia policies, payer contracts and government fee schedules. In addition, the Revenue Integrity Specialist is also responsible for addressing requests for  Care Center payment performance audits to assist in maximizing cash flow, as well as, tracking and reporting the outcomes of both standard payer audits and requested Care Center audits. This position works collaboratively with our operations consultants, RCM AR staff and management.    

Primary Job Duties:

• Auditing across all systems to ensure new provider and care center information is accurate
• Ensure reimbursement by payer is accurate per payer contract agreements, government and state rates by auditing payer processed claims
• Conduct Care Center audits following the audit policy based on the number of providers on a 30/60/90/120 post implementation/go-live date 
• Assist the Sr. Manager, RI to lead initiatives that drive efficiency and partner internally and externally to deliver expected results (e.g; monthly market meetings with leadership, internal team meetings and meetings with top commercial payers)
• Make independent decisions regarding audit results, communicate with appropriate teams; contract negotiators, senior leaders,  market leaders and/or directly with the payer to ensure optimal revenue opportunity
• Create, follow and ensure adherence to approved escalation processes to timely issue resolution and completion of action plans.   
• Identify, monitor and manage denial management trends. Work closely with our Revenue Cycle Teams, payer representatives and create one pagers/reference tools on payer policies.
• Assist with Trizetto/Cognizant setup, fee schedule setup
• Work and address Salesforce cases along with athenaOne tables
• Perform other duties as assigned focused on key performance and department goals

Colorado, New York, New Jersey, California and Washington Residents Only: The salary range for this role is $56,028 to $60,900 in base pay and exclusive of any bonuses or benefits. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

Qualifications

• Education: High School Graduate 
• Advanced Microsoft Excel skills (ex: pivot table, VLOOKUP, sort/filtering and , formulas) 
• 3+ years payer contracts (language) and/or auditing payer payments
• Must be analytical, identify payment variance due to contract build or process errors, resolve payment issues, track & analyze payer information/policies.
• Experience working in Trizetto EOB resolve tool or equivalent use of contract management/software 
• 3+ years of experience in a medical billing office preferred
• athenaOne software system experience is preferred
• Must comply with HIPAA rules and regulations

Additional Information

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

Privia Health is committed to providing equal employment opportunity to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, Privia will provide reasonable accommodations for qualified individuals with disabilities. Privia's goal is for our people to reflect the communities that we serve and to increase representation of women, people of color, veterans and individuals with disabilities in our organization.

Technical Requirements (for remote workers):

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. Th