Revenue Integrity Training Specialist

Role Description

We are seeking a highly motivated and detail-oriented Revenue Integrity Training Specialist to join our team. This dual-role position is crucial for maintaining the financial health of our regional operations by ensuring accurate charging, billing, and coding practices. The ideal candidate will possess a strong background in healthcare revenue cycle, auditing, documentation, training, and process improvement. The specialist will be responsible for conducting rigorous audits to identify and resolve payment discrepancies and denial trends, while simultaneously developing standard operating procedures (SOPs) and training new team members to uphold best practices across the region.

• Research, develop and maintain concise written procedures and processes for internal RCM team(s), cross-functionally when needed.
• Design training plans for new Privians, both within and outside of RCM Optimization.
• Develop and document all workflow processes and procedures adhering to best practice standards.
• Develop alternative training methods if expected improvements are achieved.
• Complete monthly payer and fee schedule audits, charge alerts, and downcoding in compliance with Privia policies, payer contracts, and government fee schedules.
• Ensure reimbursement by payer is accurate.
• Make independent decisions regarding audit results, communicate with appropriate teams to ensure optimal revenue opportunity.
• Identify, monitor and inform the RCM team of denial trends creating revenue delays and leakages.
• Assist with Trizetto/Cognizant setup, fee schedule setup.
• Work and address Salesforce cases in a timely manner.
• Address requests for Care Center payment performance audits to assist in maximizing cash flow, as well as tracking and reporting the outcomes of both scheduled payer audits and requested Care Center audits.
• Evaluate training progress and competency by conducting routine quality audits, providing meaningful feedback to RCM leadership.
• Coordinate all aspects of training activities.
• Special projects and other duties as assigned, focused on key performance and department goals.

Qualifications

• 3+ years of experience in a medical billing office preferred.
• 3+ years of experience with payer contracts (language) and/or auditing payer payments.
• Experience working in Trizetto EOB resolve a plus.
• AthenaOne software system experience is a plus.
• Experience with multiple RCM functions, including a thorough understanding of revenue integrity processes and impact is a plus.
• Experience with Google Suite: Sheets, slides, forms preferred.
• Must be highly analytical, identify payment variance due to contract build or process errors, resolve.
• Knowledge of principles and methods for process documentation, curriculum and training design with the ability to research and review processes.
• Highly organized and able to manage multiple priorities effectively.
• A collaborative and positive team player with a desire to cultivate a culture of unconditional positive regard.
• Skilled in documenting clearly defined processes, standard operating procedures, and policies.
• Intermediate Excel Knowledge (basic formulas, pivot tables).
• Strong critical thinking and problem-solving skills.
• Must comply with HIPAA rules and regulations.

Requirements

• The salary range for this role is $60,000.00-$65,000.00 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.

Benefits

• All your information will be kept confidential according to EEO guidelines.

Technical Requirements

• 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 speedtest.net .
• Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.