Complex Medical Claims Project Specialist (Sr. AR Manager) - Privia Health

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 position is a hybrid full-time role that requires in office on Tuesdays and Thursdays at 1200 Binz St Suite 1490 Houston TX 77004. Mon, Wed, and Fri are typically work from home but subject to change for internal meetings, trainings, and conferences.*

Under the direction of the Manager of Revenue Cycle Management, the Complex Medical Claims Project Specialist (AR manager) is responsible for the consolidation of tasks between the AVP of RCM, the Manager of Revenue Optimization and the Manager of Revenue Cycle Management. This position will be responsible for research for complex Revenue Cycle projects and working on specialized projects given by the leadership team. 

Primary Job Duties:

• Runs, reviews and analyzes RCM reports and communicates denial sources and revenue cycle trends. 

• 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

• Drive toward achievement of department’s daily and monthly Key Performance Indicators (KPIs), requiring a team focused approach to attainment of these goals

• Responsible for auditing all RCM Management Reports to ensure accuracy and to identity areas of opportunity for improvement

• Ability to effectively communicate and escalate RCM issues and areas of concern.

• Other duties as assigned

• Education: High School diploma  

• Experience: 5+ years medical claims experience in a physician medical billing office

• 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

• Advanced Microsoft Excel skills

• Google Suite experience preferred

• Preference for experience working with athena EMR

• Comfortable speaking in front of groups

• Excellent written and verbal communication skills

• Self-starter with great time management skills and ability to work on multiple projects at one time

• Ability to work independently and multi-task in a fast paced environment

• Problem solver with good analytical skills and solution-oriented approach

• Strong research skills

• 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

The salary range for this role is $50,000 to $60,000 in base pay. This role is also eligible for an annual bonus targeted at 15% based on performance in the role. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

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.