Medical Claims Billing Specialist

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.

About the role

This is a hybrid full-time role that requires in-office presence on Tuesdays and Thursdays at 1200 Binz St Suite 1490, Houston, TX 77004. Mondays, Wednesdays, and Fridays are typically work-from-home days but may change for internal meetings, trainings, and conferences.

Under the direction of the Manager of Revenue Cycle Management, the Medical Claims Specialist (AR Manager) is responsible for complete, accurate, and timely processing of all designated claims, reviewing and responding to daily correspondence from physician practices, and managing SalesForce cases. This role involves resolving claim issues, managing denial appeals, and collaborating with internal teams to ensure optimal revenue cycle functionality.

Responsibilities

• Denial management: investigating denial sources, resolving and appealing denials, which may include contacting payer representatives
• Making independent decisions regarding claim adjustments, resubmission, appeals, and other claim resolution techniques
• Collaborating with internal teams (Performance, Operations, Sales) as well as care center staff when appropriate
• Working closely with the Revenue Optimization team to support efforts ensuring reimbursement aligns with payer contract agreements
• Working directly with practice consultants or physicians to ensure optimal revenue cycle functionality
• Driving toward achievement of the department’s daily and monthly Key Performance Indicators (KPIs) with a team-focused approach
• Other duties as assigned

Requirements

• High School diploma
• 3+ years of medical claims experience in a physician medical billing office
• Understanding of the drivers of revenue cycle optimal performance and ability to investigate and resolve complex claims
• Advanced Microsoft Excel skills (e.g., pivot tables, VLOOKUP, sort/filtering, formulas) preferred
• Understanding of Explanation of Benefit (EOB) statements
• Google Suite experience preferred
• Athena EMR experience preferred
• Accessibility to a private, quiet workspace with high-speed internet for remote workdays
• Comfortable speaking in front of groups
• Excellent written and verbal communication skills
• Willingness to train and mentor other team members
• Self-starter with strong time management skills
• Ability to work independently and multi-task in a fast-paced environment
• Problem solver with good analytical skills and a solution-oriented approach
• Independent decision-maker with strong research skills
• Compliance with HIPAA rules and regulations

Pay

The hourly range for this role is $24/hr - $26.45/hr in base pay, exclusive of any bonus or benefits. This role is also eligible for an annual bonus targeted at 10% based on performance.

Benefits

• Medical, dental, and vision insurance
• Life and pet insurance
• 401K
• Paid time off
• Other wellness programs

Schedule

Hybrid schedule: in-office on Tuesdays and Thursdays; remote on Mondays, Wednesdays, and Fridays (subject to change for meetings, trainings, and conferences).

Technical Requirements

For remote workdays, a minimum internet speed of 5 MBPS download and 3 MBPS upload is required. Employees working remotely are eligible for expense reimbursement to offset this cost.