Manager, Revenue Cycle

Priviahealth; Houston (TX); Hybride; USD 70 000 - 72 000; Plein temps

Avantages offerts par ce poste

Annual bonus (15%)

Restricted stock units

Medical insurance

Dental, vision, life insurance

401K

Paid time off

Wellness programs

Résumé du poste

Priviahealth in Houston seeks a Senior Manager, Revenue Cycle Management to oversee claims submission, follow-up, and AR resolution. You will lead payer projects, analyze denials, and drive improvements while coaching a growing team and ensuring HIPAA compliance.

The role requires 5+ years in physician revenue cycle management and 2+ years in people management, with experience in athenaOne, Trizetto, and Salesforce.

Qualifications

• 5+ years experience in managing physician revenue cycle.
• 2+ years experience in management of personnel.
• Must understand drivers of revenue cycle performance and resolve complex claims.
• HIPAA compliance; strong training and claims management skills.
• Experience with athenaOne, Trizetto and Salesforce.

Responsabilités

• Oversee claims submission and follow-up to ensure timely resolution.
• Lead large payer projects and care center support initiatives.
• Identify process improvements and report opportunities to leadership.
• Manage AR aged analysis, root causes, and denials patterns.
• Develop training programs and coach team members for KPI attainment.

Connaissances

Revenue cycle management

Staff management

Training

Process improvement

Formation

High School Diploma

Medical Office training certificate

Outils

athenaOne

Trizetto

Salesforce

Description du poste

This full-time position is a hybrid role that requires working in the office on Tuesdays and Thursdays at 1200 Binz St Suite 1490 Houston TX 77004. Mon, Wed, and Fri are typically work from home but may be in office on occasion.

Under the direction of the Associate Director, Director, or AVP of Revenue Cycle Management, the

Senior Manager, Revenue Cycle Management, is responsible for oversight and training of staff,

management of functions and processes and accountable for the team hitting performance, quality and

production metrics. In addition, the Sr. Manager will support the Gulf Coast Market RCM Associate

Directors with escalations and larger strategic projects as needed.

The Manager is responsible for ensuring that the Accounts Receivables are worked in accordance

with best practices and that all Manager Holds, Zero Pay, Unapplied, Unpostables and other Aged

Accounts Receivable are reviewed, reconciled and resolved in a timely and compliant manner.

Additionally, they 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 as well as

management of the team resolving the cases is a key element in this role. We look for strong training and claims management skills along with strict attention to detail, a solutions focused mindset, and a driving

work ethic.

Primary Job Duties

Oversee the entire claims submission and follow-up process, ensuring claims are worked accurately for resolution, submitted accurately and on time

• Lead and manage large payer projects and care center support projects, updating leadership and affected stakeholders as needed
• Keep ADs AVP abreast of opportunities for improvement in daily operations along with recommendations on process improvements
• Management of the teams accountable for the accounts receivable (AR) including analysis and resolution of the aged AR, looking for root cause issues
• Utilize data to identify patterns in claim denials or delays and develop actionable solutions to address them
• Independent decision making -regarding claim adjustments, resubmission, appeals, and other claim resolution techniques
• Makes policy updates as needed, to all RCM policies.
• Met with the Performance Operations, Implementation, Sales and other Privia teams, review escalated issues and discuss payer or claim concerns.
• Met with Care Center leadership including the lead physician partners, office managers and other staff to discuss complex claim or other revenue cycle matters
• Laser focused drive toward achievement of department's daily and monthly KPIs, requiring a team focused approach to attainment of these goals
• Identify gaps in the workflow and create training programs to address them.
• Responsible for performing or assisting with duties related to staffing to include hiring, termination, coaching and training
• Provides ongoing feedback to staff regarding of performance throughout the year
• Counsels employees in disciplinary matters and obtains assistance from human resources appropriately for disciplinary actions and/or employee termination process
• Serve as the lead or co-presenter at various meetings, including Office Manager Summits, Provider POD Meetings, and Market Retreats.
• Other duties as assigned
• High School Graduate, Medical Office training certificate or relevant experience
• 5+ years experience in managing physician revenue cycle
• 2+ years experience in management of personnel
• Must understand the drivers of revenue cycle optimal performance and be able to investigate and resolve complex claims.
• Strong preference for experience working with athenaOne, Trizetto and Salesforce
• Must comply with HIPAA rules and regulations

The salary range for this role is $70,000.00-$72,000.00 in base pay and exclusive of any bonuses 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 15% and restricted stock units. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

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 expen