Sr. Manager, Revenue Integrity

Company Description

Under the direction of the AD, Revenue Optimization, The Sr. Manager, Revenue Integrity is responsible for complete, accurate and timely processing of reimbursement/payment audits (Nationally) utilizing the Trizetto/Cognizant application, as well as Care Center payment performance audits, upon requests from Performance Management. They are also responsible for maintaining a relationship with our Trizetto/Cognizant Account Manager. Additionally, they are to track and report the outcomes of both standard payer audits and requested Care Center audits. Additionally, They are to review and respond to daily correspondence from internal/external customers in a timely manner, answer incoming Salesforce cases and provide information as requested or properly authorized. This position works collaboratively with management and staff and routinely follows accepted safety practices.

Job Description

• Lead and manage a team of revenue integrity specialists responsible for national audits focused on underpayment recoveries and billing accuracy
• Nationally, manage signed contracts and fee schedules/rates; create and load within Privia’s contract system (Trizetto/Cognizant) and update the Master Tracker by market/payer
• Audit payor processed claims; ensure reimbursement by payer is accurate per payor contract agreements, government and state rates Nationally
• Lead initiatives to drive efficiency and partner internally and externally to deliver expected results; monthly market meetings with leadership, internal team meetings and with top commercial payers etc
• Makes independent decisions regarding audit results, communicates with appropriate teams; contract negotiators, senior leaders, market leaders and/or directly with the payer to ensure optimal revenue opportunity
• Create, follow and ensure adherence to approved escalation processes to timely issue resolution and completion of action plans
• Assist senior leaders in projects/urgent audits or care center/provider concerns
• Identify, monitor and manage denial management; identify trends work closely with our Revenue Cycle Team by market and/or payer representatives and create one pagers/reference tools on payer policies
• Assists with analysis on contract/payer issues for new contract negotiations
• Serve as a coach to peers and team members and act as a resource for escalated issues
• Provide management, guidance, and training to staff and perform duties of subordinate staff as needed
• Responsible for staffing to include hiring, termination, coaching and training
• Provide ongoing feedback to subordinate staff regarding performance throughout the year
• Coordinate and communicate with third party vendor partners as needed
• Other duties as assigned

Qualifications

• High School Graduate, Medical Office training certificate preferred 
• 5+ years experience in a medical in …