Medical Claims Billing Specialist (Fulltime Temp)

Privia Health•Houston, TX

4d•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 full-time position is a hybrid role that requires working in the office on Tuesdays and Thursdays at 1200 Binz St Suite 1490 Houston TX 77004. Mon, Wed, and Fri are typically work from home but may be in office on occasion. Under the direction of the AVP of Revenue Cycle Management, the Accounts Receivable (AR) Manager is responsible for ensuring the accurate and timely processing of all assigned claims. This role includes promptly addressing daily correspondence from physician practices, reviewing and appealing insurance claim denials and following up on aged claims. The AR Manager will take the steps necessary to resolve all claim issues or questions that escalate to the RCM team to include Salesforce case management.

Requirements

High School Graduate
3+ years experience in a medical billing office or equivalent claims experience
Must understand the drivers of revenue cycle optimal performance and be able to investigate and resolve complex claims
Advanced Microsoft Excel skills (ex: pivot tables, VLOOKUP, sort/filtering, formulas) preferred
Must comply with HIPAA rules and regulations

Nice To Haves

Experience with athenaHeath and/or athenaOne preferred

Responsibilities

Management of the accounts receivable (AR) including analysis of the aged AR, looking for root cause issues; suggesting billed rules/edits when appropriate to stop errors from occurring
Denial management - investigate denial sources, resolve and appeal denials which may include contacting payer representatives
Make 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
Support large care center go lives when applicable, which may include overnight travel
Work closely with our Revenue Optimization team to support efforts to ensure reimbursement is in line with payer contract agreements.
Perform 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)
Other duties as assigned