Sr. Manager, Revenue Cycle Management

Privia Health•Houston, TX

17h•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 Associate Director, Director, or AVP of Revenue Cycle Management, the Senior Manager, Revenue Cycle Management, is responsible for oversight and training of staff, management of functions and processes and accountable for the team hitting performance, quality and production metrics. In addition, the Sr. Manager will support the Gulf Coast Market RCM Associate Directors with escalations and larger strategic projects as needed. The Sr. Manager is responsible for ensuring that the Accounts Receivables are worked in accordance with best practices and that all Manager Holds, Zero Pay, Unapplied, Unpostables and other Aged Accounts Receivable are reviewed, reconciled and resolved in a timely and compliant manner. Additionally, they will take steps necessary to resolve all claim issues or questions that escalate to the RCM team. Resolution of SalesForce cases and management of issues as well as management of the team resolving the cases is a key element in this role. We look for strong training and claims management skills along with strict attention to detail, a solutions focused mindset, and a driving work ethic.

Requirements

High School Graduate, Medical Office training certificate or relevant experience
5+ years experience in managing physician revenue cycle
3+ years experience in management of personnel
Must understand the drivers of revenue cycle optimal performance and be able to investigate and resolve complex claims.
Must comply with HIPAA rules and regulations

Nice To Haves

Strong preference for experience working with athenaOne, Trizetto and Salesforce

Responsibilities

Oversee the entire claims submission and follow-up process, ensuring claims are worked accurately for resolution, submitted accurately and on time
Lead and manage large payer projects and care center support projects, updating leadership and affected stakeholders as needed
Keep ADs AVP abreast of opportunities for improvement in daily operations along with recommendations on process improvements
Management of the teams accountable for the accounts receivable (AR) including analysis and resolution of the aged AR, looking for root cause issues
Utilize data to identify patterns in claim denials or delays and develop actionable solutions to address them
Independent decision making -regarding claim adjustments, resubmission, appeals, and other claim resolution techniques
Makes policy updates as needed, to all RCM policies.
Meets with the Performance Operations, Implementation, Sales and other Privia teams, review escalated issues and discuss payer or claim concerns.
Meets with Care Center leadership including the lead physician partners, office managers and other staff to discuss complex claim or other revenue cycle matters
Laser focused drive toward achievement of department’s daily and monthly KPIs, requiring a team focused approach to attainment of these goals
Identify gaps in the workflow and create training programs to address them.
Responsible for performing or assisting with duties related to staffing to include hiring, termination, coaching and training
Provides ongoing feedback to subordinate staff regarding of performance throughout the year to subordinate staff
Counsels employees in disciplinary matters and obtains assistance from human resources appropriately for disciplinary actions and/or employee termination process
Serve as the lead or co-presenter at various meetings, including Office Manager Summits, Provider POD Meetings, and Market Retreats.
Other duties as assigned