AR & Case Management Specialist

Privia Health•Remote, USA

10d•$23 - $25•Hybrid

About The Position

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. Additionally, the Senior AR Manager is responsible for overseeing functions within Accounts Receivable in accordance with compliant best practices, such as Claims Worklists, Zero Pay, Unapplied, and Denials, to ensure that all are reviewed, reconciled and resolved in a timely matter. The Senior AR Manager will also serve as an subject matter expert and point of escalation on one of our internal sub-teams.

Requirements

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
Must comply with HIPAA rules and regulations
Excellent written and verbal communication

Nice To Haves

Microsoft Excel skills (ex: pivot tables, VLOOKUP, sort/filtering, formulas) preferred
Experience working with athenaOne suite of tools preferred
Experience with VA payers & providers preferred

Responsibilities

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