Full-Time Revenue Integrity Specialist
Privia Health is hiring a remote Full-Time Revenue Integrity Specialist. The career level for this job opening is Experienced and is accepting USA based applicants remotely. Read complete job description before applying.
Privia Health
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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.
Primary Job Duties:
- 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, 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.
Education: High School Graduate
Skills: Advanced Microsoft Excel skills (ex: pivot table, VLOOKUP, sort/filtering, and formulas).
Experience: 3+ years payer contracts (language) and/or auditing payer payments. Experience working in Trizetto EOB resolve tool or equivalent use of contract management/software.
Preferred: 3+ years of experience in a medical billing office. athenaOne software system experience.
Compensation: $55,000 - $60,000 in base pay, plus potential 15% annual bonus, and benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, wellness programs).