Revenue Integrity Training Specialist

Privia Health•Remote, USA

1d•Remote

About The Position

We are seeking a highly motivated and detail-oriented Revenue Integrity Training Specialist to join our team. This dual-role position is crucial for maintaining the financial health of our regional operations by ensuring accurate charging, billing, and coding practices. The ideal candidate will possess a strong background in healthcare revenue cycle, auditing, documentation, training and process improvement. The specialist will be responsible for conducting rigorous audits to identify and resolve payment discrepancies and denial trends, while simultaneously developing standard operating procedures (SOPs) and training new team members to uphold best practices across the region.

Requirements

3+ years of experience in a medical billing office preferred
3+ years of experience with payer contracts (language) and/or auditing payer payments
Experience working in Trizetto EOB resolve a plus
AthenaOne software system experience is a plus
Experience with multiple RCM functions, including a thorough understanding of revenue integrity processes and impact is a plus
Experience with Google Suite: Sheets, slides, forms preferred
Must be highly analytical, identify payment variance due to contract build or process errors, resolve
Knowledge of principles and methods for process documentation, curriculum and training design with the ability to research and review processes.
Highly organized and able to manage multiple priorities effectively
A collaborative and positive team player with a desire to cultivate a culture of unconditional positive regard
Skilled in documenting clearly defined processes, standard operating procedures, and policies
Intermediate Excel Knowledge (basic formulas, pivot tables)
Strong critical thinking and problem solving skills
Must comply with HIPAA rules and regulations

Nice To Haves

Experience working in Trizetto EOB resolve
AthenaOne software system experience
Experience with multiple RCM functions, including a thorough understanding of revenue integrity processes and impact
Experience with Google Suite: Sheets, slides, forms

Responsibilities

Research, develop and maintain concise written procedures and processes for internal RCM team(s), cross-functionally when needed.
Design training plans for new Privians, both within and outside of RCM Optimization.
Develop and document all workflow processes and procedures adhering to best practice standards.
Develop alternative training methods if expected improvements are achieved
Complete monthly payer and fee schedule audits, charge alerts and downcoding in compliance with Privia policies, payer contracts and government fee schedules.
Ensure reimbursement by payer is accurate.
Make independent decisions regarding audit results, communicate with appropriate teams to ensure optimal revenue opportunity.
Identify, monitor and inform the RCM team of denial trends creating revenue delays and leakages.
Assist with Trizetto/Cognizant setup, fee schedule setup.
Work and address Salesforce cases in a timely manner.
Address requests for Care Center payment performance audits to assist in maximizing cash flow, as well as, tracking and reporting the outcomes of both scheduled payer audits and requested Care Center audits.
Evaluate training progress and competency by conducting routine quality audits, providing meaningful feedback to RCM leadership
Coordinate all aspects of training activities
Special projects and other duties as assigned, focused on key performance and department goals.