Medical Claims Billing Specialist - Orthopedic

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 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

Minimum Qualifications

• Education: High School Graduate

• Experience: 3+ years experience in a physician medical billing office

• Must understand the drivers of revenue cycle optimal performance and be able to investigate and resolve complex claims.

• Experience using athenaHealth EMR required

• Experience with Orthopedic billing preferred

• Experience with California payers preferred

• Must provide accessibility to private quiet work space with high-speed internet to effectively work remotely

• 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 paced environment

• Technically capable

The salary range for this role is $55000.00- $60000.00 in base pay and exclusive of any bonuses or benefits. 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 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.