Medical Claims Specialist (AR Manager)

Company Description

Privia Health™ is a national physician platform transforming the healthcare delivery experience. We provide tailored solutions for physicians and providers, creating value and securing their future. Through high-performance physician groups, accountable care organizations, and population health management programs, Privia works in partnership with health plans, health systems, and employers to better align reimbursements to quality and outcomes.

Job Description

*This position is a hybrid role that requires in office on Tuesdays and Thursdays at 1200 Binz St Suite 1490 Houston TX 77004. Mon, Wed, and Fri are typically work from home.*

Under the direction of the Manager of Revenue Cycle Management, the Medical Claims Specialist (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 Medical Claims Specialist 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. 

Primary Job Duties:

• 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

• Collaborate internal teams (Performance, Operations, Sales) as well as care center staff when appropriate

• Works closely with our Revenue Optimization team, to support efforts to ensure reimbursement is in line with payer contract agreements. Performs 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), requiring a team focused approach to attainment of these goals

• Other duties as assigned

Qualifications

• Education: High School diploma preferred 

• Experience: 3+ years medical claims experience in a physician medical billing office; Medicaid experience preferred.

• Must understand the drivers of revenue cycle optimal performance and be able to investigate and resolve complex claims.

• Must understand Explanation of Benefit (EOB) statements

• Advanced Microsoft Excel skills

• Preference for experience working with athenaHealth’s suite of tools

• Must provide accessibility to private, quiet work space with high-speed internet to effectively work remotely for days not in the office

• Must comply with HIPAA rules and regulations 

Interpersonal Skills & Attributes:

• Comfortable speaking in front of groups

• Excellent written and verbal communication

• Willingness to train and mentor other team members

• Self-starter with great time management skills

• Ability to work independently and multi-task in a fast paced environment

• Technically capable and savviness

• Problem solver with good analytical skills and solution-oriented approach

• Independent decision maker with strong research skills

Additional Information

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

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. 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 https://www.speedtest.net/. 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. Privia is a better company 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