RCM Systems Specialist - Remote, USA, United States
1 day ago
Job description
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 Senior Manager, Revenue Optimization the Revenue Optimization & Systems Specialist is responsible for the maintenance and accuracy of the medical group's chargemaster and fee schedules, answers support requests from internal stakeholders and physician partners, and supports the successful configuration of RCM systems for newly onboarded provider groups.
Chargemaster Management
- Process and implement requested edits or updates to the medical chargemaster/fee schedules within a defined service level agreement (SLA).
- Evaluate and process requests for changes to the service pricing by following established best-practice policies for approval or denial.
- Act as the internal subject matter expert, collaborating with clinical and operations teams to ensure compliance with payer guidelines and governmental regulations.
- Execute and manage annual projects specifically for updating and incorporating the new flu season CPT/HCPCS codes.
- Support the development and implementation of new market chargemasters in direct collaboration with the implementation project leader.
Conflict Resolution
- Manage, investigate, and respond to incoming inquiries and issues reported through the Salesforce case management system.
- Implement and ensure standardization of policies across all markets
- Maintain a focused effort toward meeting and exceeding the department's daily and monthly Key Performance Indicators (KPIs).
Data Maintenance & Standardization
- Develop expertise in managing and configuring tablespace-wide settings within the athenaOne and all relevant systems.
- Design, test, and implement rule edits within the athenaOne EHR system.
- Execute complete tablespace builds and configurations for onboarding new provider groups.
Qualifications
- High School Graduate
- Medical billing (CPT/HCPCs) experience preferred
- Experience with athenaHeath and/or athenaOne required
- Must comply with HIPAA rules and regulations
- Advanced analytical skills, including Microsoft Excel skills (ex: pivot tables, VLOOKUP, sort/filtering, formulas)
- Experience using Salesforce for case management preferred
The salary range for this role is $60,000.00-$65,000.00 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 10%. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.
Additional Information
All 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 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. We understand that healthcare is local and we are better 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.
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