Medical Claims Billing & Case Management Specialist

Privia Health • Remote, USA

2d • $23 - $25 • Remote

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. 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 using Salesforce for case management preferred
• Must provide accessibility to private, quiet work space with high-speed internet to effectively work remotely (if a remote worker)
• 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

Benefits

• medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs
• annual bonus targeted at 10%
• expense reimbursement to offset the cost of internet for remote workers

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: High school or GED