Privia Health is hiring a Privia Health Medical Claims Billing Specialist | SmartRecruiters

Medical Claims Billing Specialist Full-time Department: Revenue Cycle Company Description HealthTech Innovations is a forward-thinking organization that partners with medical practices, insurance networks, and healthcare systems to optimize physician performance, enhance patient interactions, and reward providers for delivering high-quality care in both in-person and virtual environments. The organization's platform leverages top industry talent and exceptional medical leadership, utilizing scalable operations and comprehensive cloud-based technology to reduce unnecessary healthcare expenditures, achieve superior outcomes, and improve patient health and provider well-being. Under the supervision of the Revenue Cycle Management Director or Manager, the Medical Claims Billing Specialist (Accounts Receivable Manager) is responsible for comprehensive, precise, and timely processing of designated claims, reviewing and responding to daily correspondence from physician practices promptly, addressing incoming SalesForce cases, and providing authorized information. The AR Manager will implement necessary steps to resolve claim issues or questions escalated to the RCM team. Resolving SalesForce cases and managing issue resolution are critical components of this role. Primary Job Duties: - Manage accounts receivable, including aged AR analysis, identifying root cause issues, and developing rules to prevent errors - Denial management - investigating denial sources, resolving and appealing denials, including direct communication with payer representatives - Make independent decisions regarding claim adjustments, resubmission, appeals, and other claim resolution techniques - Collaborate with internal teams (Performance, Operations, Sales) and care center staff - Potentially support large care center go-lives, which may require overnight travel - Work closely with Revenue Optimization team to ensure reimbursement aligns with payer contract agreements - Perform denial analysis using Trizetto platform - Directly engage with practice consultants or physicians to ensure optimal revenue cycle functionality - Drive achievement of department's daily and monthly Key Performance Indicators through team-focused approach - Additional responsibilities as assigned Qualifications: - High School Graduate - 3+ years experience in physician medical billing office - Understanding of revenue cycle performance drivers - Ability to investigate and resolve complex claims - Experience with major payers (Anthem, Medicare/Medicaid, United Healthcare, Carefirst) - Athena EHR experience required - Experience supporting medical claims billing in DC/MD/VA preferred - Advanced Microsoft Excel skills - Proficiency in Google Sheets - HIPAA compliance - Experience with Washington payors preferred - Prior Rural Health Clinic experience a plus Compensation Range: $24-$26 hourly base pay, excluding bonuses and benefits. Eligible for 10% annual bonus. Base pay determined by experience, education, and location. Additional Information: Information kept confidential per EEO guidelines Technical Requirements (remote workers): - Minimum 5 MBPS download speed - Minimum 3 MBPS upload speed - Internet speed verification recommended - Potential expense reimbursement for home office costs Privia Health values diversity and encourages opportunities for all, regardless of personal characteristics, fostering an inclusive work environment reflective of the communities served.