Medical Billing Specialist-Nc & Oh

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.

Under the direction of the Manager of Revenue Cycle Management, the Medical Claims Specialist (AR Manager) is responsible for complete, accurate and timely processing of all designated claims, reviewing and responding to daily correspondence from physician practices in a timely manner, answering incoming SalesForce cases and providing information as requested or properly authorized. The Medical Claims Specialist 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 and the team resolving the cases is a key element in this role.
Primary Job Duties

• Drive toward achievement of department’s daily and monthly Key Performance Indicators (KPIs), requiring a team focused approach to attainment of these goals
• Collaborate internal teams (Performance, Operations, Sales) as well as care center staff when appropriate
• Work directly with practice consultants or physicians to ensure optimal revenue cycle functionality
• Denial management - investigating denial sources, resolving and appealing denials which may include contacting payer representatives
• Other duties as assigned
• Works closely with our Revenue Optimization team, to support efforts to ensure reimbursement is in line with payer contract agreements. Performs Denial analysis utilizing the Trizetto platform
• Makes independent decisions regarding claim adjustments, resubmission, appeals, and other claim resolution techniques

Qualifications

• Preference for experience working with athenaHealth’s suite of tools
• Must comply with HIPAA rules and regulations
• Must provide accessibility to private, quiet work space with high-speed internet to effectively work remotely for days not in the office
• Experience: 3+ years medical claims experience in a physician medical billing office; Medicaid experience preferred.
• Education: High School diploma preferred
• Advanced Microsoft Excel skills
• Must understand the drivers of revenue cycle optimal performance and be able to investigate and resolve complex claims.
• Must understand Explanation of Benefit (EOB) statements
• Experience supporting North Carolina and/or Ohio payers preferred

Interpersonal Skills & Attributes

• Comfortable speaking in front of groups
• Self-starter with great time management skills
• Problem solver with good analytical skills and solution-oriented approach
• Excellent written and verbal communication
• Independent decision maker with strong research skills
• Willingness to train and mentor other team members
• Ability to work independently and multi-task in a fast paced environment
• Technically capable and savviness

Colorado, New York, New Jersey, California and Washington Residents Only: The salary range for this role is $50,000.00-$60,000.00 in base pay and exclusive of any bonuses or benefits. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.
Additional Information
All of your information will be kept confidential according to EEO guidelines.
Technical Requirements (for remote workers only, not applicable for onsite/in office work):
In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like https://www.speedtest.net/. This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.
Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. Privia is a better company when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age, color, national origin, physical or mental (dis)ability, race, religion, gender, sex, gender identity and/or expression, marital status, veteran status, or any other characteristic protected by federal, state or local law.