Revenue Integrity Specialist

Role 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. This position works collaboratively with our operations consultants, RCM AR staff, and management.

• 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 (e.g., 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.

Requirements

• 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.

Benefits

• All of 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 .
• 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.

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.