Medical Claims Billing Specialist

Privia Health; Houston (TX); Ibrido; USD 33.000 - 36.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical insurance

Dental insurance

Vision insurance

Life insurance

Pet insurance

401K

Paid time off

Wellness programs

Descrizione del lavoro

Privia Health in Houston is seeking a Medical Claims Specialist (AR Manager) to ensure complete, accurate, and timely processing of designated claims. You will respond to SalesForce cases and collaborate with cross-functional teams to resolve issues affecting reimbursement.

This hybrid, full-time role requires in-office presence on Tuesdays and Thursdays, with Mondays, Wednesdays, and Fridays often remote. The ideal candidate has 5+ years of medical claims experience, understands EOBs, and can

Competenze

• 5+ years medical claims experience in a physician medical billing office.
• Must understand the drivers of revenue cycle performance and resolve complex claims.
• Must understand Explanation of Benefit (EOB) statements.
• Athena EMR experience preferred.
• Must provide access to a private, quiet workspace with high-speed internet for remote days.
• Willingness to train and mentor other team members.
• HIPAA compliance required.

Mansioni

• Denial management - investigate denial sources, resolve and appeal denials with payer reps.
• Decide on claim adjustments, resubmissions, 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.
• Work with practice consultants or physicians to optimize revenue cycle functionality.
• Pursue daily and monthly KPIs with a team-focused approach.
• Perform any other duties as assigned.

Conoscenze

Medical billing

Denials management

Analytical skills

Time management

Strumenti

Athena EMR

Descrizione del lavoro

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 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, 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 Specialist will take steps necessary to resolve all claim issues or questions that escape 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+ years medicalclaimsexperience 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 remotely for days not in the office

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 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
• pet insurance
• 401K
• paid time off
• 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.