Claims Billing Specialist

Company Description

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.

Job Description

Under the direction of the Director or Manager 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.

Primary Job Duties:

• 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 via phone

• 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

Qualifications

• High School Graduate

• 3+ years experience in a medical billing office or equivalent claims experience