Medical Claims Billing Specialist

Privia Health is a technology-driven national physician enablement company that partners with medical groups, health plans, and health systems to improve physician practices, patient experiences, and care delivery across in-person and virtual settings.

This role is responsible for the accurate and timely processing of assigned claims under the direction of the Manager of Revenue Cycle Management. The position handles daily correspondence from physician practices, reviews and appeals insurance claim denials, and follows up on aged claims. It also supports claim issue resolution for matters that escalate to the revenue cycle management team, including Salesforce case management.

Primary responsibilities

• Manage accounts receivable, including analysis of aged AR and identification of root-cause issues
• Recommend billing rules or edits to prevent recurring errors
• Investigate denial sources and resolve or appeal denied claims, including payer follow-up when needed
• Make independent decisions regarding claim adjustments, resubmissions, appeals, and other resolution actions
• Collaborate with internal teams and care center staff as needed
• Support large care center go-lives, which may include overnight travel
• Work with the Revenue Optimization team to help ensure reimbursement aligns with payer contract agreements
• Perform denial analysis using the Trizetto platform
• Partner with practice consultants or physicians to support optimal revenue cycle performance
• Meet daily and monthly departmental KPIs
• Perform other duties as assigned