Medical Claims Billing Specialist

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

Benefits offered by this job

Medical insurance

Dental insurance

401K

Paid time off

Job summary

Privia Health is a technology-driven physician enablement company offering a hybrid full-time Revenue Cycle Management role in Houston. The Medical Claims Specialist (AR Manager) processes claims, responds to Salesforce cases, and collaborates with care teams to resolve issues.

Denial management and KPI-driven targets are central to the role. The position requires 3+ years of medical claims experience, advanced Excel, and HIPAA compliance.

Qualifications

• 3+ years medical claims experience in a physician billing office.
• Medicare and Medicare Advantage experience preferred.
• Understanding of Explanation of Benefit (EOB) statements.
• Advanced Microsoft Excel skills.
• Preference for experience working with athena.
• Must provide accessible private, quiet workspace with high-speed internet for remote days.
• 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 strong analytical 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.
• Decide on claim adjustments, resubmission, appeals, and other resolution techniques.
• Collaborate with internal teams (Performance, Operations, Sales) and care center staff.
• Support Revenue Optimization to ensure reimbursement aligns with payer contracts; perform denial analysis using Trizetto.
• Work with practice consultants or physicians to ensure revenue cycle functionality.
• Drive toward KPIs with a team-focused approach.
• Other duties as assigned.

Skills

Medical claims experience

Excel skills

EOB knowledge

HIPAA compliance

Athena experience

Public speaking

Mentoring

Time management

Independent work

Problem solving

Research skills

Revenue cycle

Tools

athenahealth

Microsoft Excel

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.

Job Description

*This positionis 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, theMedical Claims Specialist (ARManager)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. TheMedical Claims Specialistwill take steps necessary to resolve all claim issues or questions that escalated 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 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. Performs Denial analysis utilizing the Trizetto platform

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

Qualifications

Experience: 3+ yearsmedicalclaimsexperience in a physician medical billing office;Medicare and Medicare Advantage experience preferred.

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

Advanced Microsoft Excel skills

Preference for experience working with athena

Must provide accessibility to private, quiet work space with high-speed internet to effectively work remotelyfor days not in the office

Comfortable speaking in front of groups

Willingness to train and mentor other team members

Self-starter withgreat 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.

Additional Information

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.