Medical Claims Billing 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.

Job Description

Under the direction of the Director or Manager of Revenue Cycle Management, the Accounts Receivable (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 AR Manager 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:

• Management of the accounts receivable (AR) including analysis of the aged AR, looking for root cause issues; writing rules where appropriate to stop errors from occurring.
• 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.
• At times, support large care center go lives which may include overnight travel.
• 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

• High School Graduate
• 3+ years experience in a physician medical billing office
• Experience with major payers such as Anthem, Medicare/Medicaid, United Healthcare
• Athena EHR experience preferred
• Must understand the drivers of revenue cycle optimal performance and be able to investigate and resolve complex claims
• Advanced Microsoft Excel skills
• Must comply with HIPAA rules and regulations 

Interpersonal Skills & Attributes:

• Comfortable speaking in front of groups
• Excellent written and verbal communication
• Willingness to train and mentor other team members
• Great time management skills
• Ability to work independently and multi-task in a fast …