RCM Case Management Specialist

Privia Health

23h•Hybrid

About The Position

Under the direction of the Associate Director or Manager of Revenue Cycle Management, the Accounts Receivable (AR) Case Management Specialist is responsible for ensuring the accurate and timely processing of all claims concerns or claim projects. This role acts as a bridge between financial accuracy and efficient communication, promptly addressing daily correspondence from physicians, care centers, vendors, and internal teams to resolve insurance claim denials. By leveraging Salesforce case management workflows, the AR Manager ensures that all claim issues or questions escalating to the RCM team are tracked, managed, and resolved with accountability.

Requirements

High School Graduate.
3+ years in a medical billing office or equivalent claims experience.
Must understand the drivers of revenue cycle performance and be able to resolve complex, multi-layered claim issues.
Must strictly comply with all HIPAA rules, regulations, and company policies regarding information privacy.

Nice To Haves

Advanced Microsoft Excel skills (e.g., pivot tables, VLOOKUP, formulas) preferred.
Experience with athenaHealth/athenaOne and Salesforce (specifically Case Management) is highly preferred

Responsibilities

Manage the full cycle of Salesforce cases, ensuring all RCM-related inquiries are documented, categorized, and resolved within established Service Level Agreements (SLAs).
Monitor Salesforce dashboards to identify practice inquiries trends and report on case resolution efficiency to leadership.
Deep expertise in billing, AR follow up, and denial management to promote one touch resolution of escalated cases.
Make independent decisions regarding claim adjustments, resubmissions, and other advanced resolution techniques in accordance with company policies and best practices.
Collaborate with internal teams and care center staff to streamline workflows and resolve escalated billing hurdles.
Utilize the Trizetto to perform denial analysis and initiate requests to add rules or edits to prevent recurring errors.
Work directly with practice consultants or physicians to ensure optimal revenue cycle functionality and drive department Key Performance Indicators (KPIs).
Other duties as assigned.