Medical Claims Billing Specialist

Privia Health•Houston, TX

2d•Hybrid

About The Position

Privia Health is seeking a Medical Claims Billing Specialist for 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 remote, subject to change for internal meetings, trainings, and conferences. Remote work requires a private, quiet workspace and high-speed internet; remote employees need at least 5 Mbps download and 3 Mbps upload speeds. Employees who regularly work from home offices are eligible for expense reimbursement to offset internet costs. Under the direction of the Manager of Revenue Cycle Management, the specialist is responsible for complete, accurate, and timely processing of designated claims; responding to physician-practice correspondence; handling incoming Salesforce cases; and resolving claims issues escalated to the revenue cycle management team. The role also involves managing Salesforce cases and supporting the team that resolves them. The position pays $24 to $26.45 per hour in base pay, exclusive of benefits, and is eligible for an annual bonus targeted at 10% based on performance. Benefits listed include medical, dental, vision, life, and pet insurance, a 401(k), paid time off, and wellness programs. Base pay is determined by relevant factors such as experience, education, and geographic location.

Requirements

High school diploma.
At least 5 years of medical claims experience in a physician medical billing office.
Understanding of the drivers of optimal revenue cycle performance and ability to investigate and resolve complex claims.
Understanding of Explanation of Benefit (EOB) statements.
Private, quiet workspace and high-speed internet for remote work; minimum 5 Mbps download and 3 Mbps upload speeds.
Comfortable 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 ability, good analytical skills, and a solution-oriented approach.
Independent decision-making ability and strong research skills.
Must comply with HIPAA rules and regulations.

Nice To Haves

Advanced Microsoft Excel skills, such as pivot tables, VLOOKUP, sorting/filtering, and formulas.
Google Suite experience.
Athena EMR experience.

Responsibilities

Investigate denial sources and resolve or appeal denials, including by contacting payer representatives.
Make independent decisions regarding claim adjustments, resubmissions, appeals, and other claim-resolution techniques.
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 accordance with payer contract agreements.
Work directly with practice consultants or physicians to support optimal revenue cycle functionality.
Contribute to achievement of department daily and monthly KPIs through a team-focused approach.
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 the team resolving them.
Perform other duties as assigned.

Benefits

Medical insurance
Dental insurance
Vision insurance
Life insurance
Pet insurance
401(k)
Paid time off
Wellness programs
Home-office expense reimbursement for employees who regularly work from home offices
Annual bonus targeted at 10% based on performance