Revenue Optimization & Systems Specialist

Company Description

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.

Job Description

Under the direction of the Senior Manager, Revenue Optimization the Revenue Optimization & Systems Specialist is responsible for the maintenance and accuracy of the medical group’s chargemaster and fee schedules, answers support requests from internal stakeholders and physician partners, and supports the successful configuration of RCM systems for newly onboarded provider groups.

Primary Job Duties:

• Chargemaster Management

• Respond in a timely manner to requests for edits or updates to the medical chargemaster

• Follow best practice policies for approving or denying requests

• Become an internal expert on chargemaster best practices to ensure compliance with governmental regulations and payer guidelines. Work collaboratively with operations and clinical departments to ensure rules are followed.

• Manage annual projects for flu season and new codes

• Support the build of new market chargemasters in collaboration with implementation project leaders

• Issue Management       

• Triage, research, and reply to various inbound requests through Salesforce case management

• Ensure consistent delivery of Revenue Optimization policy across multiple medical groups

• Laser-focused drive toward the achievement of the department’s daily and monthly KPIs

• Data Maintenance & Standardization

• Become an expert on tablespace-wide athenaOne settings

• Manage and support billing and edit rules within athenaOne system

• Complete tablespace builds for new provider groups

• Monitor performance of offshore staff, as needed

• Support development and testing of RPA, robotic process automation build

Qualifications

• Education: High School Graduate

• Microsoft excel and google suite experience, advanced skills strongly preferred

• Medical billing or coding experience is a plus

• athenaOne experience is a plus

• Must comply with HIPAA rules and regulations

Preferred Qualifications

• Advanced Microsoft Excel skills strongly preferred  (ex: VLOOKUP, sort/filtering/formatting, pivot table, and formulas)

• Medical billing and coding knowledge preferred 

• Experience using Salesforce for case management

The salary range for this role is $55,200.00-$60,000.00 in base pay and exclusive of any bonuses or benefits. This role is also eligible for an annual bonus targeted at 10%. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

Additional Information

All your information will be kept confidential according to EEO guidelines.

Technical Requirements (for remote workers only, not applicable for onsite/in office work):

In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like https://www.speedtest.net/. This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.

Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. Privia is a better company when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age, color, national origin, physical or mental (dis)ability, race, religion, gender, sex, gender identity and/or expression, marital status, veteran status, or any other characteristic protected by federal, state or local law.