Medical Claims Project Specialist

4 days ago


Houston, Texas, United States Privia Health Full time
Job Description

Company Overview

Privia Health is a leading technology-driven 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 a 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 Summary

We are seeking a highly skilled Complex Medical Claims Project Specialist to join our Revenue Cycle Management team. The successful candidate will be responsible for consolidating tasks between the AVP of RCM, the Manager of Revenue Optimization, and the Manager of Revenue Cycle Management.

Key Responsibilities

  • Revenue Cycle Analysis: Run, review, and analyze RCM reports to communicate denial sources and revenue cycle trends.
  • Denial Analysis: Work closely with the Revenue Optimization team to support efforts to ensure reimbursement is in line with payer contract agreements. Perform denial analysis utilizing the Trizetto platform.
  • Key Performance Indicators (KPIs): Drive toward achievement of department's daily and monthly KPIs, requiring a team-focused approach to attainment of these goals.
  • RCM Management Reports: Responsible for auditing all RCM Management Reports to ensure accuracy and to identify areas of opportunity for improvement.
  • Communication and Escalation: Ability to effectively communicate and escalate RCM issues and areas of concern.

Qualifications

  • Education: High School diploma
  • Experience: 5+ years medical claims experience in a physician medical billing office
  • Revenue Cycle Expertise: Must understand the drivers of revenue cycle optimal performance and be able to investigate and resolve complex claims.
  • EOB Statement Understanding: Must understand Explanation of Benefit (EOB) statements.
  • Technical Skills: Advanced Microsoft Excel skills, Google Suite experience preferred, and comfort with athena EMR.
  • Soft Skills: Excellent written and verbal communication skills, self-starter with great time management skills, and ability to work on multiple projects at one time.
  • Problem-Solving: Problem solver with good analytical skills and solution-oriented approach.
  • Research Skills: Strong research skills.
  • Compliance: Must comply with HIPAA rules and regulations.

Compensation

The salary range for this role is $50,000 to $60,000 in base pay. This role is also eligible for an annual bonus targeted at 15% based on performance in the role.

Technical Requirements

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.


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