Senior Revenue Cycle Leader - Hybrid, KPI-Driven

Privia Health; Houston (TX); Hybrid; USD 75,000 - 80,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

Pet insurance

401K

Paid time off

Wellness programs

Annual bonus

Restricted stock units

Job summary

Privia Health is seeking a Senior Manager, Revenue Cycle Management for a hybrid role in Houston. You will supervise staff, optimize accounts receivable processes, and drive performance, quality, and production metrics across the Gulf Coast market.

The role requires 5+ years in revenue cycle management, 3+ years in people management, and familiarity with athenaOne, Trizetto, and Salesforce. HIPAA compliance is mandatory.

Qualifications

• High School Graduate, Medical Office training certificate or relevant experience.
• 5+ years experience in managing physician revenue cycle.
• 3+ years experience in management of personnel.
• Must understand the drivers of revenue cycle optimal performance and be able to investigate and resolve complex claims.
• Strong preference for experience working with athenaOne, Trizetto and Salesforce.
• Must comply with HIPAA rules and regulations.

Responsibilities

• Oversee the entire claims submission and follow-up process, ensuring claims are worked accurately for resolution, submitted accurately and on time.
• Lead and manage large payer projects and care center support projects, updating leadership and affected stakeholders as needed.
• Keep ADs AVP abreast of opportunities for improvement in daily operations along with recommendations on process improvements.
• Management of the teams accountable for the accounts receivable (AR) including analysis and resolution of the aged AR, looking for root cause issues.
• Utilize data to identify patterns in claim denials or delays and develop actionable solutions to address them.
• Independent decision making regarding claim adjustments, resubmission, appeals, and other claim resolution techniques.
• Makes policy updates as needed, to all RCM policies.
• Meets with the Performance Operations, Implementation, Sales and other Privia teams, review escalated issues and discuss payer or claim concerns.
• Meets with Care Center leadership including the lead physician partners, office managers and other staff to discuss complex claim or other revenue cycle matters.
• Laser focused drive toward achievement of department’s daily and monthly KPIs, requiring a team focused approach to attainment of these goals.
• Identify gaps in the workflow and create training programs to address them.
• Responsible for performing or assisting with duties related to staffing to include hiring, termination, coaching and training.
• Provides ongoing feedback to staff regarding of performance throughout the year.
• Counsels employees in disciplinary matters and obtains assistance from human resources appropriately for disciplinary actions and/or employee termination process.
• Serve as the lead or co-presenter at various meetings, including Office Manager Summits, Provider POD Meetings, and Market Retreats.
• Other duties as assigned

Skills

Revenue cycle management

Staff management

HIPAA compliance

Communication

Education

High School Diploma

Tools

athenaOne

Trizetto

Salesforce

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 full-time position is a hybrid role that requires working in the office on Tuesdays and Thursdays at 1200 Binz St Suite 1490 Houston TX 77004. Mon, Wed, and Fri are typically work from home but may be in office on occasion.

Under the direction of the Associate Director, Director, or AVP of Revenue Cycle Management, the
Senior Manager, Revenue Cycle Management, is responsible for oversight and training of staff,
management of functions and processes and accountable for the team hitting performance, quality and
production metrics. In addition, the Sr. Manager will support the Gulf Coast Market RCM Associate
Directors with escalations and larger strategic projects as needed.

The Manager is responsible for ensuring that the Accounts Receivables are worked in accordance
with best practices and that all Manager Holds, Zero Pay, Unapplied, Unpostables and other Aged
Accounts Receivable are reviewed, reconciled and resolved in a timely and compliant manner.
Additionally, they will take steps necessary to resolve all claim issues or questions that
escalate to the RCM team. Resolution of SalesForce cases and management of issues as well as
management of the team resolving the cases is a key element in this role. We look for strong training and claims management skills along with strict attention to detail, a solutions focused mindset, and a driving
work ethic.

Primary Job Duties:

Oversee the entire claims submission and follow-up process, ensuring claims are worked
accurately for resolution, submitted accurately and on time
• Lead and manage large payer projects and care center support projects, updating leadership and
affected stakeholders as needed
• Keep ADs AVP abreast of opportunities for improvement in daily operations
along with recommendations on process improvements
• Management of the teams accountable for the accounts receivable (AR) including analysis and
resolution of the aged AR, looking for root cause issues
• Utilize data to identify patterns in claim denials or delays and develop actionable solutions to
address them
• Independent decision making -regarding claim adjustments, resubmission, appeals, and other
claim resolution techniques
• Makes policy updates as needed, to all RCM policies.
• Meets with the Performance Operations, Implementation, Sales and other Privia teams, review
escalated issues and discuss payer or claim concerns.
• Meets with Care Center leadership including the lead physician partners, office managers and
other staff to discuss complex claim or other revenue cycle matters
• Laser focused drive toward achievement of department’s daily and monthly KPIs, requiring a
team focused approach to attainment of these goals
• Identify gaps in the workflow and create training programs to address them.
• Responsible for performing or assisting with duties related to staffing to include hiring,
termination, coaching and training
• Provides ongoing feedback to staff regarding of performance throughout the year
• Counsels employees in disciplinary matters and obtains assistance from human resources
appropriately for disciplinary actions and/or employee termination process
• Serve as the lead or co-presenter at various meetings, including Office Manager Summits,
Provider POD Meetings, and Market Retreats.
• Other duties as assigned

Qualifications

• High School Graduate, Medical Office training certificate or relevant experience
• 5+ years experience in managing physician revenue cycle
• 2+ years experience in management of personnel
• Must understand the drivers of revenue cycle optimal performance and be able to investigate and
resolve complex claims.
• Strong preference for experience working with athenaOne, Trizetto and Salesforce
• Must comply with HIPAA rules and regulations

The salary range for this role is $70,000.00-$72,000.00 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 15% and restricted stock units.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.

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