Medical Claims Billing Specialist

SmartRecruiters, Inc.; Houston (TX); On-site; USD 33,000 - 36,000; Full time

Job summary

Privia Health in Houston is seeking a Medical Claims Specialist (AR Manager) to oversee complete, accurate, and timely processing of designated claims within a hybrid setting. You will handle denials, appeals, and collaborate with internal teams to resolve issues efficiently.

Under the Manager of Revenue Cycle Management, you will resolve complex claims, manage Salesforce cases, and drive KPIs while maintaining HIPAA compliance and high service standards.

Qualifications

• 5+ years medical claims experience in a physician billing office.
• Understand drivers of revenue cycle performance and be able to investigate complex claims.
• Must provide accessibility to private, quiet workspace with high-speed internet for remote days.

Responsibilities

• Denial management—investigating denial sources, resolving and appealing denials.
• Make independent decisions regarding claim adjustments, resubmission, appeals, 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 ensure optimal revenue cycle functionality.
• Drive toward the department's KPIs with a team-focused approach.

Skills

Medical claims experience

HIPAA compliance

Time management

Tools

Athena EMR

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 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

Qualifications

5+ yearsmedicalclaimsexperience in a physician medical billing office

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

Athena EMR experience preferred

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.