Claims Billing Specialist (Athena EMR)

Privia Health; United States; Remote; USD 33,000 - 36,000; Full time

Job summary

Privia Health is seeking a Claims Billing Specialist (AR Manager) to ensure accurate and timely processing of claims. You will address daily correspondence from physician practices, review denials, and follow up on aged claims, including Salesforce case management where needed.

Your role will involve denial management, independent adjustments, and collaboration with Performance, Operations, Sales, and care center staff. Occasional overnight travel may be required as part of large go-live support.

Qualifications

• 3+ years experience in a medical billing office or equivalent claims experience.
• Must understand drivers of revenue cycle performance and resolve complex claims.
• Advanced Excel/Google Sheets skills (pivot tables, VLOOKUP, sort/filtering, formulas).
• Experience with athenaHealth and/or athenaOne preferred.
• HIPAA compliance required.

Responsibilities

• Manage accounts receivable including aged AR analysis and root-cause issues.
• Investigate denial sources, resolve and appeal denials.
• Make independent decisions on claim adjustments, resubmission, appeals.
• Collaborate with internal teams and care centers as needed.
• Support large care center go-lives, may require overnight travel.
• Work with Revenue Optimization to ensure reimbursement aligns with contracts.
• Profile/drove KPIs for the department; engage with consultants and physicians.

Skills

Denial management

Revenue cycle analysis

Excel/Google Sheets

Education

High School Diploma

Tools

Excel/Google Sheets

athenaHealth/athenaOne

Salesforce

Job description

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.

Job Description

Under the direction of the Director or Manager of Revenue Cycle Management, the Claims Billing Specialist (official title: AR Manager) is responsible for ensuring the accurate and timely processing of all assigned claims. This role includes promptly addressing daily correspondence from physician practices, reviewing and appealing insurance claim denials and following up on aged claims. The AR Manager will take the steps necessary to resolve all claim issues or questions that evolve to the RCM team to include Salesforce case management.

Primary Job Duties:

Management of the accounts receivable (AR) including analysis of the aged AR, looking for root cause issues; suggesting billed rules/edits when appropriate to stop errors from occurring

Denial management - investigate denial sources, resolve and appeal denials which may include contacting payer representatives via phone

Make 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

Support large care center go lives when applicable, which may include overnight travel

Work closely with our Revenue Optimization team to support efforts to ensure reimbursement is in line with payer contract agreements. Perform denial analysis utilizing the Trizetto platform.

Work directly with practice consultants or physicians to ensure optimal revenue cycle functionality

Drive toward achievement of department’s daily and monthly Key Performance Indicators (KPIs)

Other duties as assigned

Qualifications

High School Graduate

3+ years experience in a medical billing office or equivalent claims experience

Must understand the drivers of revenue cycle optimal performance and be able to investigate and resolve complex claims

Advanced Microsoft Excel/Google Sheets skills (ex: pivot tables, VLOOKUP, sort/filtering, formulas) preferred

Experience with athenaHeath and/or athenaOne highly preferred

Experience working with New Jersey payers and providers preferred

Must comply with HIPAA rules and regulations

Independent decision maker with strong research skills

Must comply with HIPAA rules and regulations

The hourly range for this role is $24/hr - 26.45/ hr in base pay and exclusive of any bonus or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 10% based on performance in the role. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

Additional Information

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 whenour 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.