Full-Time Manager, Revenue Integrity

Under the direction of the Sr. Director, the Manager, Revenue Integrity is responsible for processing complete, accurate and timely payment audits across all markets utilizing the Trizetto/Cognizant application. Also responsible for maintaining Privia’s day-to-day relationship with our Trizetto/Cognizant Account Manager. Track and report the outcomes of both standard payer audits and requested Care Center audits. Review and respond to daily correspondence from internal/external customers. This position works collaboratively with management and staff.

• Nationally manage signed contracts and fee schedules/rates; create and load within Privia’s contract system (Trizetto/Cognizant) and update the Master Tracker by market/payer
• Audit payor processed claims; ensure reimbursement by payer is accurate per payor contract agreements, government and state rates
• Lead initiatives to drive efficiency and partner internally and externally to deliver expected results; monthly market meetings with leadership, internal team meetings and with top commercial payers etc
• Makes independent decisions regarding audit results, communicates 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
• Assist senior leaders in projects/urgent audits or care center/provider concerns
• Identify, monitor and manage denial management; identify trends work closely with our Revenue Cycle Team by market and/or payer representatives and create one pagers/reference tools on payer policies
• Assists with analysis on contract/payer issues for new contract negotiations
• Provide management, guidance and training to staff and other team members as needed
• Other duties as assigned

Experience:

• 5+ years experience in auditing, preferrably within revenue cycle
• 3+ years of people management experience required
• Experience managing offshore resources preferred
• Strong analytical and reporting skills required
• Experience interpreting contract language and identifying payment variance due to contract build or process errors
• Ability to research and interpret payer information and policies
• Extensive experience working with Trizetto’s EOBresolve tool or equivalent contract management software preferred
• Experience working with Athenahealth’s suite of tools preferred
• Analytical skills and advanced Excel skills (ex: pivot tables, VLOOKUP, sort/filtering and formulas)
• Must comply with HIPAA rules and regulations
• Excellent written and verbal communication
• Great time and project management skills
• Ability to prioritize and escalate issues as appropriate
• Ability to work independently and multi-task in a fast paced environment

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