Medical Claims Specialist - Houston, United States - Privia Health

Privia Health
Privia Health
Verified Company
Houston, United States

2 weeks ago

Mark Lane

Posted by:

Mark Lane

beBee recruiter
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.


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:


  • Denial management investigating denial sources, resolving and appealing denials which may include contacting payer representatives
  • Makes independent decisions regarding claim adjustments, resubmission, appeals, and other claim resolution techniques
  • Collaborate internal teams (Performance, Operations, Sales) as well as care center staff when appropriate
  • 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
  • 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), requiring a team focused approach to attainment of these goals
  • Other duties as assigned

Qualifications

  • Education: High School diploma
  • Experience: 3+ years medical claims experience in a physician medical billing office; Medicare and Medicare Advantage experience preferred.
  • 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
  • Must provide accessibility to private, quiet work space with highspeed internet to effectively work remotely for days not in the office
  • Comfortable speaking in front of groups
  • Excellent written and verbal communication
  • Willingness to train and mentor other team members
  • Selfstarter with great time management skills
  • Ability to work independently and multitask in a fast paced environment
  • Problem solver with good analytical skills and solutionoriented approach
  • Independent decision maker with strong research skills
  • Must comply with HIPAA rules and regulations


The salary range for this role is $48,000 to $55,000 in base pay is also eligible for an annual bonus target at 10% based on performance in the role.

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):

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.

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