Hybrid Medical Claims Specialist: Denials & RCM

Privia Health, LLC; Houston (TX); Hybrid; USD 33,000 - 36,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

Pet insurance

401K

PTO

Wellness programs

Job summary

Privia Health, LLC is hiring a Medical Claims Specialist (AR Manager) to oversee complete and timely processing of designated claims and respond to daily correspondence from physician practices. You will resolve complex denials, manage SalesForce cases, and support the Revenue Cycle Management team to optimize reimbursements.

The role emphasizes independent decision-making, collaboration with cross-functional teams, and mentoring colleagues in a fast-paced, HIPAA-compliant environment.

Qualifications

• 5+ 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.
• Athena EMR experience preferred.
• Must provide accessibility to private, quiet work space with high-speed internet to effectively work remotely for days not in the office.
• Comfortable speaking in front of groups.
• Willingness to train and mentor other team members.
• Self-starter with great time management skills.
• Ability to work independently and multi-task in a fast paced environment.
• Problem solver with good analytical skills and solution-oriented approach.
• Independent decision maker with strong research skills.
• Must comply with HIPAA rules and regulations

Responsibilities

• 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.
• Works closely with our Revenue Optimization team, to support efforts to ensure reimbursement is in line with payer contract agreements.
• Work directly with practice consultants or physicians to ensure optimal revenue cycle functionality.
• Drive toward achievement of department’s daily and monthly KPIs, requiring a team focused approach to attainment of these goals.
• Other duties as assigned

Skills

Medical claims experience

HIPAA compliance

Public speaking

Tools

Athena EMR

Job description

Privia Health, LLC is hiring a Medical Claims Specialist (AR Manager) to oversee complete and timely processing of designated claims and respond to daily correspondence from physician practices. You will resolve complex denials, manage SalesForce cases, and support the Revenue Cycle Management team to optimize reimbursements.

The role emphasizes independent decision-making, collaboration with cross-functional teams, and mentoring colleagues in a fast-paced, HIPAA-compliant environment.