RCM Quality & Audit Specialist

About the role

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.

Responsibilities

• Conduct quality reviews, audit revenue cycle claims and workflows against established standard operating procedures (SOPs)
• Develop, collect, analyze, report and measure multiple quality improvement initiatives that supports RCM operational functions
• Create and maintain quality measurements to track improvements in individual and team performance scores
• Identify potential deficiencies in processes via analysis and trends
• Create reports and deliver assessment/evaluation results to appropriate levels of leadership
• Research and identify the “root cause analysis” in process improvement (e.g. Ability to identify when a function/action was performed that is not included in the SOP or documentation available) and utilize audit findings to report trends and recommended training
• Assist with establishing, updating and communicating new and existing procedures
• Analyze and measure results of implemented policies and changes
• Collaborate with various RCM Leaders and internal partners to ensure goals are being met
• Serve as a SME on all RCM workflows that are being audited
• Participate in special projects, audits and process improvements in support of quality assurance initiatives
• Other duties, as assigned i.e. coordinate and serve as supplemental support to the National Training Team

Qualifications

• Associate’s or bachelor’s degree preferred
• Experience with statistical analysis preferred
• 3+ years experience in an auditing/QA role or equivalent RCM job related experience
• 2+ years experience with athenaHeath and/or athenaOne preferred

Skills

• Advanced working knowledge of Google Suite: Sheets, Slides and Forms
• Advanced Excel skills to include the ability to use formulas to analyze data, create graphs and pivot tables
• Experience managing data located in multiple software systems
• Experience documenting clearly defined processes, standard operating procedures and policies
• Demonstrates effective written and verbal communication skills with the ability to self-edit
• Must demonstrate strong interpersonal skills to interact positively and effectively
• Ability to work in a very fast-paced and changing work environment
• Must comply with HIPAA rules and regulations
• Collaborative, customer-focused and able to create visible value
• Ability to