Full-Time Medical Claims Billing Specialist

Medical Claims Billing Specialist (Unpostables)

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. Review and respond to daily correspondence from physician practices. Answer incoming telephone calls or Salesforce cases and provide 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 staff in physician practices and team members at Privia Headquarters.

1. Unpostables management: Research and resolve records that haven't been matched to athenaNet related charges (including insurance payments, capitation payments, patient payments, remittance items, and voided charges).
2. Reconciliation: Reconcile re-adjudicated claims/payer takebacks.
3. Accounts Receivable (AR) Management: Analyze aged AR, look for root cause issues, and write rules to stop errors.
4. Denial Management: Investigate denial sources, resolve and appeal denials (contacting payer representatives where needed).
5. Claim Resolution: Make independent decisions regarding claim adjustments, resubmission, appeals, and other claim resolution techniques.
6. Web Portal Maintenance: Maintain web portal access for all payers and interface with Athena to update the master list of portal addresses.
7. Policy Updates: Make policy updates as needed to all RCM policies.
8. Internal and Care Center Training: Train internal teams (Operations, Sales), and care center staff when appropriate.
9. Practice Consultant Collaboration: Work directly with practice consultants or physicians to ensure optimal revenue cycle functionality.
10. KPI Achievement: Achieve department daily and monthly Key Performance Indicators (KPIs) through a team-focused approach.

• Technical Requirements (Remote Only): A minimum of 5 MBPS download speed and 3 MBPS upload speed is required.

Essential Skills & Attributes

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

Education and Experience

• High School Graduate
• Medical Office training certificate or relevant experience (preferred)
• 3+ years experience in a medical billing office
• Experience with Athena EMR (preferred)
• Understanding of revenue cycle optimal performance and ability to investigate and resolve complex claims
• Compliance with HIPAA rules and regulations

What is the last date for applying to the job?

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