Manager, Revenue Cycle

Privia Health; Town of Texas (WI); Hybrid; USD 70,000 - 72,000; Full time

Job summary

Privia Health is seeking a Senior Manager, Revenue Cycle Management for a hybrid role based in Houston, TX. The position oversees claims submission, AR analysis, and payer project leadership to hit KPIs and drive process improvements.

Responsibilities include staff oversight, training, and escalation management with collaboration across Privia teams. 5+ years in revenue cycle and 2+ years in management are required; salary ranges and a 15% bonus are offered.

Qualifications

• 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.
• High School Graduate, Medical Office training certificate or relevant experience.

Responsibilities

• 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.
• Meet with Performance Operations, Implementation, Sales and other Privia teams, review escalated issues and discuss payer or claim concerns.
• Meet 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 staffing duties including hiring, termination, coaching and training
• Provide ongoing feedback to staff regarding performance throughout the year
• Counsels employees in disciplinary matters and coordinates with HR as needed
• Serve as lead or co-presenter at meetings such as Office Manager Summits, Provider POD Meetings, Market Retreats.

Skills

Revenue cycle management

People management

HIPAA compliance

athenaOne

Salesforce

Trizetto

Education

High School diploma or equivalent

Tools

AthenaOne

Trizetto

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

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 escalates 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 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.