Medical Claims Billing Specialist (Unpostables)

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.

Under the direction of the Sr. Manager, Unpostables of Revenue Cycle Management, the Accounts Receivable (AR) Manager - Unpostables 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 telephone calls or SalesForce cases and providing information as requested or properly authorized. We look for strong follow up skills, attention to detail, a solutions focused mindset, and a driving work ethic. This position works collaboratively with the staff in our physician practices as well as team members at Privia Headquarters.

Primary Job Duties:

• Unpostables management-researching and resolving records that have not been matched to athenaNet related charges (including insurance payments, capitation payments, patient payments, remittance items and voided charges).  Reconciliation of re-adjudicated claims/payer takebacks.
• Management of the accounts receivable (AR) including analysis of the aged AR, looking for root cause issues; writing rules where appropriate to stop errors from occurring.
• 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.
• Maintain web portal access for all payers and interface with Athena to update the master list of portal addresses for the Athena database.
• Makes policy updates as needed, to all RCM policies.
• Responsible for training internal teams (Operations, Sales) as well as care center staff when appropriate.
• Work directly with practice consultants or physicians to ensure optimal revenue cycle functionality
• Laser focused drive toward achievement of department’s daily and monthly Key Performance Indicators (KPIs), requiring a team focused approach to attainment of these goals.

• High School Graduate, Medical Office training certificate or relevant experience preferred. 
• 3+ years experience in a medical billing office.
• Experience with Athena EMR preferred
• Must understand the drivers of revenue cycle optimal performance and be able to investigate and resolve complex claims.
• Must comply with HIPAA rules and regulations

Interpersonal Skills & Attributes:

• Excellent written and verbal communication
• Experience in a people management function preferred
• Willingness to train and mentor other team members
• Excellent time management skills
• Ability to work independently and multi-task in a fast paced environment
• Technically capable and savvy

The hourly range for this role is $25.00-$26.45 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.

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. Privia is a better company 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.