Hybrid Medical Claims Specialist — Denials & RCM Expert

Privia Health; Houston (TX); Hybrid; USD 33.000 - 36.000; Vollzeit

Zusammenfassung

Privia Health is seeking a Medical Claims Specialist (AR Manager) in a hybrid role based in Houston. The position requires in-office presence on Tuesdays and Thursdays with remote work on other days, reporting to the Manager of Revenue Cycle Management.

The role focuses on complete, accurate processing of designated claims, responding to daily inquiries, and resolving claim issues escalated to the RCM team. Strong Excel and EOB knowledge are essential.

Qualifikationen

• 5+ years medical claims experience in a physician medical billing office.
• Strong understanding of revenue cycle performance.
• Advanced Excel skills (pivot tables, VLOOKUP).
• Experience with Explanation of Benefit (EOB) statements.
• Google Suite experience.
• Athena EMR experience.
• Ability to work remotely with access to a private, quiet workspace and high-speed internet.
• Excellent written and verbal communication.
• Willingness to train and mentor others.
• HIPAA compliance knowledge.

Aufgaben

• Denial management - investigate, resolve, and appeal denials.
• Make independent decisions regarding claim adjustments, resubmissions, and other resolution techniques.
• Collaborate with internal teams (Performance, Operations, Sales) and care center staff as appropriate.
• Support Revenue Optimization to ensure reimbursement aligns with payer contracts.
• Work with practice consultants or physicians to optimize revenue cycle functionality.
• Drive KPI achievement through a team-focused approach.
• Other duties as assigned.

Kenntnisse

Excel skills

Communication

Time management

Problem solving

HIPAA knowledge

Ausbildung

High School diploma

Tools

Google Suite

Athena EMR

Jobbeschreibung

Privia Health is seeking a Medical Claims Specialist (AR Manager) in a hybrid role based in Houston. The position requires in-office presence on Tuesdays and Thursdays with remote work on other days, reporting to the Manager of Revenue Cycle Management.

The role focuses on complete, accurate processing of designated claims, responding to daily inquiries, and resolving claim issues escalated to the RCM team. Strong Excel and EOB knowledge are essential.