Revenue Integrity Specialist

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

Benefits offered by this job

Medical, dental, and vision insurance

401K

Paid time off

Wellness programs

Job summary

Privia Health is seeking a Revenue Integrity Specialist to manage reimbursement audits and enhance cash flow. The candidate should possess strong analytical skills, advanced Excel proficiency, and experience with payer contracts. Key responsibilities include ensuring accurate audits, assisting with payment issues, and collaborating with various teams.

The role offers a salary range of $55,000 to $60,000 and is eligible for an annual bonus. Join Privia Health to contribute to a work environment reflecting local healthcare communities.

Qualifications

• 3+ years of experience with payer contracts and/or auditing payments.
• Experience working in Trizetto EOB resolve tool or equivalent contract management software.
• Compliance with HIPAA regulations.

Responsibilities

• Conduct audits to ensure accurate provider and care center information.
• Ensure reimbursement accuracy per payer contracts and government rates.
• Assist in the resolution of payment issues and track payer information.

Skills

Advanced Microsoft Excel skills

Analytical skills

Understanding of payer contracts

Experience in medical billing

Education

High School Graduate

Tools

Trizetto

athenaOne

Job description

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. In addition, the Revenue Integrity Specialist is also responsible for addressing requests for Care Center payment performance audits to assist in maximizing cash flow, as well as tracking and reporting the outcomes of both standard payer audits and requested Care Center audits. This position works collaboratively with our operations consultants, RCM AR staff and management.

Primary Job Duties

• Auditing across all systems to ensure new provider and care center information is accurate
• Ensure reimbursement by payer is accurate per payer contract agreements, government and state rates by auditing payer processed claims
• Conduct Care Center audits following the audit policy based on the number of providers on a 30/60/90/120 post implementation/go-live date
• Assist the Sr. Manager, RI to lead initiatives that drive efficiency and partner internally and externally to deliver expected results (e.g; monthly market meetings with leadership, internal team meetings and meetings with top commercial payers)
• Make independent decisions regarding audit results, communicate with appropriate teams; contract negotiators, senior leaders, market leaders and/or directly with the payer to ensure optimal revenue opportunity
• Create, follow and ensure adherence to approved escalation processes to timely issue resolution and completion of action plans.
• Identify, monitor and manage denial management trends. Work closely with our Revenue Cycle Teams, payer representatives and create one pagers/reference tools on payer policies.
• Assist with Trizetto/Cognizant setup, fee schedule setup
• Work and address Salesforce cases along with athenaOne tables
• Perform other duties as assigned focused on key performance and department goals

Qualifications

• Education: High School Graduate
• Advanced Microsoft Excel skills (ex: pivot table, VLOOKUP, sort/filtering and , formulas)
• 3+ years payer contracts (language) and/or auditing payer payments
• Must be analytical, identify payment variance due to contract build or process errors, resolve payment issues, track & analyze payer information/policies.
• Experience working in Trizetto EOB resolve tool or equivalent use of contract management/software
• 3+ years of experience in a medical billing office preferred
• athenaOne software system experience is preferred
• Must comply with HIPAA rules and regulations

The salary range for this role is $55,000.00-$60,000.00 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 of 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 when our 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.