Privia Health LLC
Medical Claims Billing Specialist - Case Management
Privia Health LLC, Houston, Texas, United States, 77246
Medical Claims Billing Specialist - Case Management
Hybrid full-time role that requires in-office on Tuesdays and Thursdays at 1200 Binz St Suite 1490 Houston TX 77004. Mondays, Wednesdays, and Fridays are typically work-from-home but may be required for internal meetings, trainings, and conferences. Company
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 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 Sr. Manager of Revenue Cycle Management, the Medical Claims Billing Specialist - Case Management (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 Medical Claims Specialist 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 Denial management investigating denial sources, resolving and appealing denials which may include contacting payer representatives Manage Salesforce Care Center inquiries Analyze, escalate and report out on Care Center inquiry trends 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 Work 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 departments daily and monthly KPIs, requiring a team-focused approach Other duties as assigned
Qualifications Education: High School diploma Experience: 3+ years medical claims experience in a physician medical billing office Must understand the drivers of revenue cycle performance and be able to investigate and resolve complex claims Salesforce case management experience required Must understand Explanation of Benefits (EOB) statements Advanced Microsoft Excel skills (e.g., pivot tables, VLOOKUP, sort/filtering, formulas) preferred Google Suite experience preferred Athena EMR experience preferred Must provide accessibility to private, quiet work space with high-speed internet to effectively work remotely on non-office days Comfortable speaking in front of groups Excellent written and verbal communication Willingness to train and mentor other team members Self-starter with strong time management and ability to multi-task in a fast-paced environment Problem solver with good analytical skills and a solution-oriented approach Independent decision maker with strong research skills Must comply with HIPAA rules and regulations
Compensation and Benefits The hourly range for this role is $24/hr - $26.45/hr in base pay, exclusive of any bonus or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is eligible for an annual bonus targeted at 10% based on performance. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location. Additional Information All information will be kept confidential according to EEO guidelines. Technical Requirements (for remote workers only): a minimum of 5 Mbps download and 3 Mbps upload speeds are required. This should be verified before start. The company may provide eligible expense reimbursement for remote-work setup. Privia Health is committed to a work environment that encourages bringing your whole self to work and reflects the communities served. Our goal is to ensure opportunity regardless of age, color, national origin, physical or mental disability, race, religion, gender, or any characteristic protected by law. Seniority level Associate
Employment type Full-time
Job function Other
Industries Hospitals and Health Care
Referrals increase your chances of interviewing at Privia Health. Get notified about new Medical Biller jobs in Houston, TX. Other related job titles include: Medical Billing and Coding Specialist (Clinic), Medical Billing and Collections Representative, Medical Insurance Billing Representative, Patient Support Medical Biller/Claims Processing Representative (Home-Based), Medical Billing/Verifications Specialist, Patient Account Rep - Third Party Collections, among others. #J-18808-Ljbffr
Hybrid full-time role that requires in-office on Tuesdays and Thursdays at 1200 Binz St Suite 1490 Houston TX 77004. Mondays, Wednesdays, and Fridays are typically work-from-home but may be required for internal meetings, trainings, and conferences. Company
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 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 Sr. Manager of Revenue Cycle Management, the Medical Claims Billing Specialist - Case Management (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 Medical Claims Specialist 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 Denial management investigating denial sources, resolving and appealing denials which may include contacting payer representatives Manage Salesforce Care Center inquiries Analyze, escalate and report out on Care Center inquiry trends 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 Work 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 departments daily and monthly KPIs, requiring a team-focused approach Other duties as assigned
Qualifications Education: High School diploma Experience: 3+ years medical claims experience in a physician medical billing office Must understand the drivers of revenue cycle performance and be able to investigate and resolve complex claims Salesforce case management experience required Must understand Explanation of Benefits (EOB) statements Advanced Microsoft Excel skills (e.g., pivot tables, VLOOKUP, sort/filtering, formulas) preferred Google Suite experience preferred Athena EMR experience preferred Must provide accessibility to private, quiet work space with high-speed internet to effectively work remotely on non-office days Comfortable speaking in front of groups Excellent written and verbal communication Willingness to train and mentor other team members Self-starter with strong time management and ability to multi-task in a fast-paced environment Problem solver with good analytical skills and a solution-oriented approach Independent decision maker with strong research skills Must comply with HIPAA rules and regulations
Compensation and Benefits The hourly range for this role is $24/hr - $26.45/hr in base pay, exclusive of any bonus or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is eligible for an annual bonus targeted at 10% based on performance. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location. Additional Information All information will be kept confidential according to EEO guidelines. Technical Requirements (for remote workers only): a minimum of 5 Mbps download and 3 Mbps upload speeds are required. This should be verified before start. The company may provide eligible expense reimbursement for remote-work setup. Privia Health is committed to a work environment that encourages bringing your whole self to work and reflects the communities served. Our goal is to ensure opportunity regardless of age, color, national origin, physical or mental disability, race, religion, gender, or any characteristic protected by law. Seniority level Associate
Employment type Full-time
Job function Other
Industries Hospitals and Health Care
Referrals increase your chances of interviewing at Privia Health. Get notified about new Medical Biller jobs in Houston, TX. Other related job titles include: Medical Billing and Coding Specialist (Clinic), Medical Billing and Collections Representative, Medical Insurance Billing Representative, Patient Support Medical Biller/Claims Processing Representative (Home-Based), Medical Billing/Verifications Specialist, Patient Account Rep - Third Party Collections, among others. #J-18808-Ljbffr