Medical Claims Billing Specialist

3+ years medical claims 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.

Must understand Explanation of Benefit (EOB) statements

Google Suite experience preferred

Athena EMR experience preferred

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. We understand that healthcare is local and we are better 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.

Under the direction of the Manager of Revenue Cycle Management, the Medical Claims Specialist (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.

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 with internal teams (Performance, Operations, Sales) as well as care center staff when appropriate

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.