Claims Billing Specialist (CareFirst MD)

Privia Health

6h•$24 - $26

About The Position

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 Under the direction of the Director or Manager of Revenue Cycle Management, the Medical Claims Billing Specialist (Accounts Receivable (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 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.

Requirements

High School Graduate
3+ years experience in a physician medical billing office
Athena EHR experience highly required
Must understand the drivers of revenue cycle optimal performance and be able to investigate and resolve complex claims & denial trends.
Advanced Microsoft Excel & Google Sheets skills (e.g., pivot tables, VLOOKUP, sort/filtering, formulas) and proficiency in Google Sheets preferred
Must comply with HIPAA rules and regulations

Nice To Haves

CareFirst MD experience highly preferred
Medicare Advantage & USDOL experience preferred
Experience with major payers such as Anthem, Medicare/Medicaid, United Healthcare, Carefirst also 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.
Collaborate internal teams (Performance, Operations, Sales) as well as care center staff when appropriate.
At times, support large care center go lives which may include overnight travel.
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.