Medical Claims Billing Specialist

Privia Health•Houston, TX

5d•$24 - $26•Hybrid

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. 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.

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.
Must understand Explanation of Benefit (EOB) statements
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
In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed.

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
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.
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