Medical Claims Billing Specialist - Case Management

Privia Health • Houston, TX

108d • $24 - $26

About The Position

This position is a hybrid full-time 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 but subject to change for internal meetings, trainings, and conferences. Under the direction of the Sr. Manager of Revenue Cycle Management, the Medical Claims Billing Specialist - Case Management (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.

Requirements

• High School diploma
• 3+ years medical claims experience in a physician medical billing office
• Must understand the drivers of revenue cycle optimal performance and be able to investigate and resolve complex claims
• Salesforce case management experience required
• Must understand Explanation of Benefit (EOB) statements
• Advanced Microsoft Excel skills (ex: pivot tables, VLOOKUP, sort/filtering, formulas) preferred
• Google Suite experience preferred
• Athena EMR experience preferred
• Must provide accessibility to private, quiet work space with high-speed internet to effectively work remotely for days not in the office
• 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
• Problem solver with good analytical skills and solution-oriented approach
• Independent decision maker with strong research skills
• Must comply with HIPAA rules and regulations

Nice To Haves

• Advanced Microsoft Excel skills (ex: pivot tables, VLOOKUP, sort/filtering, formulas) preferred
• Google Suite experience preferred
• Athena EMR experience preferred

Responsibilities

• Denial management - investigating denial sources, resolving and appealing denials which may include contacting payer representatives
• Manage Salesforce Care Center inquiries
• Analyze, escalate and report out on Care Center inquiry trends
• Makes independent decisions regarding claim adjustments, resubmission, appeals, and other claim resolution techniques
• Collaborate with 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

Benefits

• Medical insurance
• Dental insurance
• Vision insurance
• Life insurance
• Pet insurance
• 401K
• Paid time off
• Wellness programs
• Annual bonus targeted at 10% based on performance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees