Medical Claims Billing Specialist

Privia Health•Houston, TX

3h•$24 - $26•Hybrid

About The Position

The Medical Claims Billing Specialist is a hybrid, full-time role based in Houston, Texas. The position requires working in the office on Tuesdays and Thursdays at 1200 Binz St Suite 1490, Houston, TX 77004. Mondays, Wednesdays, and Fridays are typically work-from-home days, although this may change for internal meetings, trainings, and conferences. Remote work requires a private, quiet workspace and high-speed internet meeting the stated minimum speed requirements. Under the direction of the Manager of Revenue Cycle Management, the specialist is responsible for complete, accurate, and timely processing of designated claims; reviewing and responding to daily correspondence from physician practices; and handling incoming Salesforce cases and authorized information requests. The role resolves claim issues and questions escalated to the Revenue Cycle Management team, including managing cases and supporting the team that resolves them. The position supports denial management, claim resolution, revenue optimization, and achievement of departmental performance goals. It involves collaboration with internal teams, care center staff, practice consultants, and physicians. The role requires compliance with HIPAA rules and regulations.

Requirements

High school diploma.
At least 3 years of medical claims experience in a physician medical billing office.
Understanding of revenue cycle performance drivers and ability to investigate and resolve complex claims.
Understanding of Explanation of Benefit (EOB) statements.
Advanced Microsoft Excel skills.
Private, quiet workspace and high-speed internet for remote workdays; remote technical requirements specify at least 5 MBPS download and 3 MBPS upload.
Comfort speaking in front of groups.
Excellent written and verbal communication skills.
Willingness to train and mentor other team members.
Self-starter with strong time-management skills.
Ability to work independently and multitask in a fast-paced environment.
Problem-solving and analytical skills, with a solution-oriented approach.
Independent decision-making ability and strong research skills.
Must comply with HIPAA rules and regulations.

Nice To Haves

Medicare and Medicare Advantage experience.
Google Suite experience.
Experience working with athena.

Responsibilities

Process designated claims completely, accurately, and on time.
Review and respond promptly to daily correspondence from physician practices.
Answer incoming Salesforce cases and provide information as requested or properly authorized.
Resolve claim issues and questions escalated to the Revenue Cycle Management team, including managing cases and supporting the team resolving them.
Investigate denial sources and resolve or appeal denials, including contacting payer representatives when needed.
Make independent decisions about claim adjustments, resubmissions, appeals, and other claim-resolution approaches.
Collaborate with Performance, Operations, and Sales teams, as well as care center staff when appropriate.
Work with the Revenue Optimization team to support reimbursement in line with payer contract agreements.
Perform denial analysis using the Trizetto platform.
Work directly with practice consultants or physicians to support optimal revenue cycle functionality.
Contribute to achieving the department’s daily and monthly KPIs through a team-focused approach.
Train and mentor other team members.
Comply with HIPAA rules and regulations.
Perform other duties as assigned.