Job Description

Under the Direction of the Sr Director, Revenue Cycle Management, the Manager, Revenue Cycle Management, is responsible for overseeing the claims and collections process within the organization’s revenue cycle. This role involves managing a team to ensure timely and accurate claims submissions, follow-up, and resolution of outstanding accounts receivable. The Manager is responsible for ensuring that the Accounts Receivables are worked in accordance with best practices and that all Manager Holds, Zero Pay, Unapplied, Unpostables and other Aged Accounts Receivable are reviewed, reconciled and resolved in a timely and compliant manner. The Manager is response for monitoring the team's performance and will take steps necessary to resolve claim issues or questions that escalate to the RCM team. The ideal candidate will have strong leadership skills, extensive experience in claims management, and the ability to work collaboratively with internal departments and external stakeholders such as insurance companies.

Primary Job Duties:

•Oversee the entire claims submission and follow-up process, ensuring claims are submitted accurately and on time; specifically focused on Manager Holds with oversight of HOLDs, Zero Pay, Unapplied and Unpostables
•Lead and manage a team of AR specialists, providing guidance, training, and support
•Monitor outstanding accounts receivable, focusing on resolving aging claims and minimizing write-offs
•Ensure that denied claims are appealed in a timely manner and in accordance with payer guidelines
•Monitor and ensure all SalesForce cases are responded to and managed in a timely manner
•Conduct regular performance reviews and offer continuous coaching to improve team efficiency and productivity
•Identify opportunities for process improvements in the claims and AR workflows, implementing best practices to streamline operations
•Generate and analyze AR reports, providing insights into key metrics such as aging reports, denial trends, and collection rates
•Utilize data to identify patterns in claim denials or delays and develop actionable solutions to address them
•Liaise with insurance companies, patients, and internal departments (operations, national RCM teams, finance) to resolve claim issues and disputes
•Serve as the point of escalation for complex or high-value claims, working to resolve issues in a timely manner
•Other duties as assigned

Qualifications

• High School Graduate, Medical Office training certificate or relevant experience
• AthenaOne EMR experience required
• RHC experience preferred
• WA regional experience required
• 4+ experience in medical billing office or equivalent claims experience
• Must understand the drivers of revenue cycle optimal performance and be able to investigate and resolve complex claims.
• Experience reporting and tracking accounts receivable
• Experience working with Trizetto and SalesForce preferred
• Advanced Microsoft Excel skills (ex: pivot tables, VLOOKUP, sort/filtering, formulas) preferred
• Medical coding / billing experience preferred
• Must comply with HIPAA rules and regulations

_ The salary range for this role is $70,000 to $75,000 in base pay and exclusive of any bonus or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 15% based on the performance for the role and resricted stock units. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location._

Additional Information

All of 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 likehttps://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.