RCM Audit Specialist

Privia Health; Northern (KY); Hybrid; USD 65,000 - 70,000; Full time

Job summary

Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices and improve patient experiences in both in-person and virtual settings.

The RCM Quality & Audit Specialist role ensures accuracy, efficiency, and compliance of the organization’s revenue cycle processes, conducting audits, monitoring KPIs, and guiding process improvements for onshore and offshore resources.

Qualifications

• Background in audits/QA within revenue cycle management.
• Experience with quality reviews of claims/workflows.
• Knowledge of SOPs, policies, and HIPAA.

Responsibilities

• Conduct quality reviews and audit revenue cycle claims against SOPs.
• Develop and measure quality improvement initiatives for RCM operations.
• Create and maintain quality metrics for team performance.
• Identify process deficiencies via analysis and trends.
• Report assessment results to leadership levels.
• Research root cause analysis and use findings for training.
• Assist in updating procedures and communicating changes.
• Collaborate with RCM leaders to meet goals.
• Serve as SME on audited RCM workflows.
• Participate in special audits and process-improvement projects.
• Coordinate with National Training Team as supplemental support.

Skills

Quality assurance

Data analysis

SOPs

HIPAA compliance

Google Sheets

Excel dashboards

Audit/revenue cycle

Communication

Interpersonal skills

Education

Associate or Bachelor's degree preferred

Tools

athenaHeath

athenaOne

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

The RCM Quality & Audit Specialist is responsible for ensuring the accuracy, efficiency, and compliance of the organization's revenue cycle processes. This role involves conducting audits, monitoring key performance indicators, identifying process improvements, and ensuring compliance with industry standards and regulations, including, but is not limited to claims, denial management, and functions for both onshore and offshore resources. The ideal candidate will have a strong background in medical billing, coding, and accounts receivable, with a focus on quality assurance and process auditing.

Primary Job Duties:

• Conduct quality reviews, audit revenue cycle claims and workflows against established standard operating procedures (SOPs)
• Develop, collect, analyze, report and measure multiple quality improvement initiatives that supports RCM operational functions
• Create and maintain quality measurements to track improvements in individual and team performance scores
• Identify potential deficiencies in processes via analysis and trends
• Create reports and deliver assessment/evaluation results to appropriate levels of leadership
• Research and identify the “root cause analysis” in process improvement (e.g. Ability to identify when a function/action was performed that is not included in the SOP or documentation available) and utilize audit findings to report trends and recommended training
• Assist with establishing, updating and communicating new and existing procedures
• Analyze and measure results of implemented policies and changes
• Collaborate with various RCM Leaders and internal partners to ensure goals are being met
• Serve as a SME on all RCM workflows that are being audited
• Participate in special projects, audits and process improvements in support of quality assurance initiatives
• Other duties, as assigned i.e. coordinate and serve as supplemental support to the National Training Team

Qualifications

• Associate’s or bachelor’s degree preferred
• Experience with statistical analysis preferred
• 3+ years recent, consecutive experience in an auditing/QA role or equivalent RCM job related experience
• 2+ years experience with athenaHeath and/or athenaOne preferred
• Experience partnering with offshore RCM resources
• Advanced working knowledge of Google Suite: Sheets (pivot tables, VLOOKUP),Slides and Forms
• Advanced Excel skills to include the ability to use formulas to analyze data, create graphs and pivot tables
• Experience managing data located in multiple software systems
• Experience documenting clearly defined processes, standard operating procedures and policies
• Demonstrates effective written and verbal communication skills with the ability to self-edit
• Must demonstrate strong interpersonal skills to interact positively and effectively
• Ability to work in a very fast-paced and changing work environment
• Must comply with HIPAA rules and regulations
• Collaborative, customer-focused and able to create visible value
• Ability to prioritize tasks, use sound judgment, and remain organized
• Strong attention to detail and time management skills
• Ability to accept constructive feedback and work towards self-improvement and professional growth

The salary range for this role is $65,000.00-$70,000.00 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 10%. 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.