Revenue Integrity Specialist

Privia Health; United States; Remote; USD 55,000 - 60,000; Full time

Job summary

A leading healthcare technology company is seeking a Revenue Integrity Specialist to manage reimbursement audits and optimize revenue. The role involves collaboration with various teams to ensure compliance and accurate payment processing, with a focus on enhancing cash flow and addressing payment variances. Candidates should have strong analytical skills and advanced Excel proficiency, along with experience in payer contracts and auditing.

Benefits

Medical insurance

Dental insurance

Vision insurance

Life insurance

Pet insurance

401K

Paid time off

Wellness programs

Qualifications

• At least 3 years of experience with payer contracts and/or auditing payer payments.
• Preferred: 3+ years in a medical billing office and experience with athenaOne.

Responsibilities

• Auditing across all systems to ensure new provider and care center information is accurate.
• Ensuring reimbursement by payer is accurate per contracts and government rates.

Skills

Analytical skills

Advanced Microsoft Excel

Education

High School diploma or equivalent

Tools

Trizetto EOB resolve tool

Salesforce

athenaOne

Job description

Company 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

Under the direction of the Sr. Manager, Revenue Integrity and/or Sr. Manager, Revenue Optimization, the Revenue Integrity Specialist is responsible for complete, accurate, and timely processing of reimbursement/payment audits in compliance with Privia policies, payer contracts, and government fee schedules. Additionally, the role involves addressing requests for Care Center payment performance audits to maximize cash flow, tracking, and reporting outcomes of audits. This position collaborates with operations consultants, RCM AR staff, and management.

Primary Job Duties:

• Auditing across all systems to ensure new provider and care center information is accurate.
• Ensuring reimbursement by payer is accurate per contracts, government, and state rates by auditing payer-processed claims.
• Conducting Care Center audits based on the number of providers post-implementation (30/60/90/120 days).
• Assisting the Sr. Manager, RI in leading efficiency initiatives and partnering internally and externally to deliver results (e.g., market meetings, team meetings, payer meetings).
• Making independent decisions on audit results and communicating with relevant teams to optimize revenue.
• Creating and adhering to escalation processes for timely resolution and action plan completion.
• Monitoring denial management trends and working with Revenue Cycle Teams and payer representatives to develop reference tools on payer policies.
• Assisting with Trizetto/Cognizant setup and fee schedule configuration.
• Addressing cases in Salesforce and managing athenaOne tables.
• Performing other duties aligned with key performance and department goals.

Qualifications

• High School diploma or equivalent.
• Advanced Microsoft Excel skills (pivot tables, VLOOKUP, filters, formulas).
• At least 3 years of experience with payer contracts and/or auditing payer payments.
• Analytical skills to identify and resolve payment variances, track payer policies.
• Experience with Trizetto EOB resolve tool or similar contract management software.
• Preferred: 3+ years in a medical billing office and experience with athenaOne.
• Must comply with HIPAA regulations.

Compensation and Benefits

The salary range for this role is $55,000 to $60,000, excluding bonuses and benefits (medical, dental, vision, life, pet insurance, 401K, paid time off, wellness programs). An annual bonus of up to 15% may be awarded based on performance. The final offer depends on experience, education, and location.

Additional Information

All information will be kept confidential per EEO guidelines.

Technical Requirements (Remote Work)

Minimum internet speeds of 5 MBPS download and 3 MBPS upload are required, verified via speed tests like https://www.speedtest.net/. Employees working remotely may be eligible for expense reimbursement.

Privia Health fosters a diverse and inclusive work environment, encouraging all individuals to bring their whole selves to work, regardless of age, race, gender, disability, or other protected characteristics.