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 medical billing office or equivalent claims experience preferred
• 5+ years with payer contracts (language) and/or auditing payer payments
• Must be analytical, identify payment variance due to contract build or process errors, resolve payment issues, track & analyze payer information/policies.
• Excel functions (minimum: VLOOKUP, pivot tables, sort/filtering and formulas)
• Experience working in Trizetto EOB resolve tool or equivalent use of contract management/software
• Experience working with athenahealth’s suite of tools is preferred
• Must comply with HIPAA rules and regulations
• Excellent written and verbal communication
• Experience in a people management function (internal/ external customers and levels of senior leaders)
• Willingness to train and mentor other team members
• Great time management skills (organized and the ability to manage multiple projects while producing exceptional work. Appropriate approach for duties recognizing priorities, reporting and escalating issues and ideas through the appropriate chain of command)
• Ability to work independently and multi-task in a fast paced environment

The salary range for this role is $80,000 to $85,000 in base pay and exclusive of any bonus 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 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.

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 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.