Claims Billing Specialist

Privia Health•Remote, USA

1d•$24 - $26

About The Position

Under the direction of the Director or Manager of Revenue Cycle Management, the Claims Billing Specialist (official title: AR Manager) ensures accurate and timely processing of assigned claims. The role addresses daily correspondence from physician practices, reviews and appeals insurance claim denials, follows up on aged claims, and resolves issues escalated to the Revenue Cycle Management team, including through Salesforce case management. The position manages accounts receivable, investigates denial sources, and independently determines appropriate claim adjustments, resubmissions, appeals, and other resolution techniques. It collaborates with internal teams, care center staff, practice consultants, physicians, and the Revenue Optimization team to support effective revenue-cycle operations and reimbursement in accordance with payer contracts. The role also supports care center launches when applicable, which may involve overnight travel, and works toward daily and monthly department KPIs.

Requirements

High school graduate.
At least 3 years of experience in a medical billing office or equivalent claims experience.
Understand the drivers of optimal revenue-cycle performance and be able to investigate and resolve complex claims.
Comply with HIPAA rules and regulations.
Be an independent decision-maker with strong research skills.

Nice To Haves

Advanced Microsoft Excel or Google Sheets skills, such as pivot tables, VLOOKUP, sorting/filtering, and formulas.
Experience with athenaHealth and/or athenaOne.
Experience working with New Jersey payers and providers.

Responsibilities

Manage accounts receivable, analyze aged AR, identify root causes, and suggest billing rules or edits to prevent errors.
Investigate denial sources, resolve and appeal denials, and contact payer representatives by phone when needed.
Make independent decisions regarding claim adjustments, resubmissions, appeals, and other claim-resolution techniques.
Collaborate with Performance, Operations, and Sales teams and with care center staff when appropriate.
Support large care center go-lives when applicable, including possible overnight travel.
Work with the Revenue Optimization team to support reimbursement in line with payer contract agreements and perform denial analysis using the Trizetto platform.
Work directly with practice consultants or physicians to support optimal revenue-cycle functionality.
Work toward the department’s daily and monthly Key Performance Indicators (KPIs).
Address correspondence from physician practices, follow up on aged claims, and resolve issues escalated to the RCM team, including through Salesforce case management.
Perform other duties as assigned.

Benefits

Medical insurance
Dental insurance
Vision insurance
Life insurance
Pet insurance
401(k)
Paid time off
Wellness programs
Annual bonus targeted at 10% based on performance
Expense reimbursement for eligible employees who regularly work from home offices