Medical Claims Billing Specialist

Priviahealth; Houston (TX); Hybrid; USD 33,000 - 36,000; Full time

Job summary

Privia Health in Houston, TX is seeking a Medical Claims Specialist (AR Manager) to ensure complete, accurate, and timely processing of designated claims. The role requires in-office presence on Tuesdays and Thursdays at 1200 Binz St Suite 1490, while Mondays, Wednesdays, and Fridays are typically work-from-home but may change for internal meetings.

You will resolve complex claim issues, manage denials, and support KPI attainment across Revenue Cycle Management, collaborating with Performance,

Qualifications

• 5+ years medical claims experience in a physician medical billing office.
• Understanding of revenue cycle drivers and complex claim resolution.
• Experience with EOB statements and HIPAA rules.

Responsibilities

• Denial management: investigate, resolve, and appeal denials.
• Decide on claim adjustments, resubmission, and other resolutions.
• Collaborate with Performance, Operations, Sales, and care center staff.
• Support Revenue Optimization to align reimbursements with contracts.
• Work with practice consultants or physicians to ensure RCM functionality.
• Drive KPI achievement through team effort.
• Perform other duties as assigned.

Skills

Excellent communication

Time management

Independent worker

Analytical thinking

Public speaking

Education

High School diploma

Tools

Microsoft Excel

Google Suite

Athena EMR

Job description

*This position is a hybrid full-time role that requires in office on Tuesdays and Thursdays at 1200 Binz St Suite 1490 Houston TX 77004. Mon, Wed, and Fri are typically work from home but subject to change for internal meetings, trainings, and conferences.*

Under the direction of the Manager of Revenue Cycle Management, the Medical Claims Specialist (AR Manager) is responsible for complete, accurate and timely processing of all designated claims, reviewing and responding to daily correspondence from physician practices in a timely manner, answering incoming SalesForce cases and providing information as requested or properly authorized. The Medical Claims Specialist will take steps necessary to resolve all claim issues or questions that elevate to the RCM team. Resolution of SalesForce cases and management of issues and the team resolving the cases is a key element in this role.

Primary Job Duties

• 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 Key Performance Indicators (KPIs), requiring a team focused approach to attainment of these goals


• Other duties as assigned

Education: High School diploma

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.

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

Must understand Explanation of Benefit (EOB) statements

Google Suite experience preferred

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

Excellent written and verbal communication

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

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.

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 when our 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.