Responsibilities
- Oversee the entire claims submission and follow-up process, ensuring claims are submitted accurately and on time
- Lead and manage large payer projects and care center support projects, updating leadership and affected stakeholders as needed
- Keep ADs abreast of opportunities for improvement in daily operations along with recommendations on process improvements
- Management of the teams accountable for the accounts receivable (AR) including analysis and resolution of the aged AR, looking for root cause issues
- Utilize data to identify patterns in claim denials or delays and develop actionable solutions to address them
- Independent decision making - regarding claim adjustments, resubmission, appeals, and other claim resolution techniques
- Makes policy updates as needed, to all RCM policies.
- Meets with the Performance Operations, Implementation, Sales and other Privia teams, review escalated issues and discuss payer or claim concerns.
- Meets with Care Center leadership including the lead physician partners, office managers and other staff to discuss complex claim or other revenue cycle matters
- Responsible for training internal teams (Operations, Sales) as well as care center staff when appropriate
- Support care center go lives as needed, which may include overnight travel
- Laser focused drive toward achievement of department’s daily and monthly KPIs, requiring a team focused approach to attainment of these goals
- Responsible for performing or assisting with duties related to staffing to include hiring, termination, coaching and training
- Provides ongoing feedback to subordinate staff regarding of performance throughout the year to subordinate staff
- Counsels employees in disciplinary matters and obtains assistance from human resources appropriately for disciplinary actions and/or employee termination process
- Other duties as assigned
Requirements
- Strong training and claims management skills
- Strict attention to detail
- Solutions focused mindset
- Driving work ethic
- Oversight and training of staff
- Management of functions and processes
- Accountability for team hitting performance, quality and production metrics
- Resolution of Salesforce cases and management of issues as well as management of the team resolving the cases
- Ensuring Accounts Receivables are worked in accordance with best practices
- Timely and compliant review, reconciliation, and resolution of Manager Holds, Zero Pay, Unapplied, Unpostables, and other Aged Accounts Receivable
- Resolution of all claim issues or questions that escalate to the RCM team
Team
Structure: Manages RCM staff; collaborates with Associate Directors, Care Center leadership, and cross-functional teams including Performance Operations, Implementation, Sales, and other Privia teams.. Reports to: Sr. Director, Revenue Cycle Management
Additional Information
- Support for care center go lives may include overnight travel
