Medical Claims Specialist (Ar Manager)

Company Description
Privia Health™ is a national physician platform transforming the healthcare delivery experience. We provide tailored solutions for physicians and providers, creating value and securing their future. Through high-performance physician groups, accountable care organizations, and population health management programs, Privia works in partnership with health plans, health systems, and employers to better align reimbursements to quality and outcomes.

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

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

Qualifications

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

Interpersonal Skills & Attributes

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

Additional Information
All of your information will be kept confidential according to EEO guidelines.
Technical Requirements (for Remote Workers)
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.