Medical Claims Billing Specialist

Privia Health•Houston, TX

4d•Hybrid

About The Position

Privia Health is hiring a hybrid, full-time Medical Claims Billing Specialist. The role is based at 1200 Binz St, Suite 1490, Houston, Texas, and requires in-office work on Tuesdays and Thursdays. Mondays, Wednesdays, and Fridays are typically work-from-home days, though schedules may change for internal meetings, trainings, and conferences. Remote work requires a private, quiet workspace and high-speed internet. Under the direction of the Manager of Revenue Cycle Management, the role is responsible for accurate and timely processing of designated claims, responding to correspondence from physician practices, and handling SalesForce cases. The specialist resolves claims issues escalated to the Revenue Cycle Management team and helps manage case resolution. The position also supports revenue-cycle performance, denial management, and reimbursement in accordance with payer contracts.

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.
Ability to speak comfortably in front of groups.
Excellent written and verbal communication skills.
Willingness to train and mentor team members.
Self-starter with strong time-management skills.
Ability to work independently, multitask, and operate in a fast-paced environment.
Problem-solving ability, good analytical skills, and a solution-oriented approach.
Independent decision-making and strong research skills.
Must comply with HIPAA rules and regulations.
For remote workdays, must have access to a private, quiet workspace and high-speed internet; the stated minimum speeds are 5 Mbps download and 3 Mbps upload.

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 requested information when properly authorized.
Resolve claim issues and questions escalated to the Revenue Cycle Management team; manage issues and case resolution.
Investigate denial sources and resolve or appeal denials, including contacting payer representatives when needed.
Make decisions about claim adjustments, resubmissions, appeals, and other claim-resolution approaches.
Collaborate with Performance, Operations, Sales, and care center staff as appropriate.
Work with the Revenue Optimization team to support reimbursement in line with payer contract agreements.
Perform denial analysis using the Trizetto platform.
Work with practice consultants or physicians to support optimal revenue-cycle functionality.
Contribute to daily and monthly department KPIs through a team-focused approach.
Train and mentor other team members.
Perform other duties as assigned.