Manager, Revenue Integrity

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

Under the direction of the Sr. Director, the Manager, Revenue Integrity is responsible for processing complete, accurate and timely payment audits across all markets utilizing the Trizetto/Cognizant application, as well as Care Center payment performance audits, upon request from Performance Management. The Manager, RI is also responsible for maintaining Privia’s day-to-day relationship with our Trizetto/Cognizant Account Manager. Additionally, they are to track and report the outcomes of both standard payer audits and requested Care Center audits. They are to review and respond to daily correspondence from internal/external customers in a timely manner, and provide information as requested or properly authorized. This position works collaboratively with management and staff and routinely follows accepted safety practices.

• Nationally manage signed contracts and fee schedules/rates; create and load within Privia’s contract system (Trizetto/Cognizant) and update the Master Tracker by market/payer
• Audit payor processed claims; ensure reimbursement by payer is accurate per payor contract agreements, government and state rates Nationally
• Lead initiatives to drive efficiency and partner internally and externally to deliver expected results; monthly market meetings with leadership, internal team meetings and with top commercial payers etc
• Makes independent decisions regarding audit results, communicates with appropriate teams; contract negotiators, senior leaders, market leaders and/or directly with the payer to ensure optimal revenue opportunity
• Create, follow and ensure adherence to approved escalation processes to timely issue resolution and completion of action plans
• Assist senior leaders in projects/urgent audits or care center/provider concerns
• Identify, monitor and manage denial management; identify trends work closely with our Revenue Cycle Team by market and/or payer representatives and create one pagers/reference tools on payer policies
• Assists with analysis on contract/payer issues for new contract negotiations
• Provide management, guidance and training to staff and other team members as needed
• Other duties as assigned

• High School Graduate, Medical Office training certificate or equivalent
• Experience: 5+ years experience in auditing, preferrably within revenue cycle
• 3+ years of people management experience required
• Experience managing offshore resources preferred
• Strong analytical and reporting skills required
• Experience interpreting contract language and identifying payment variance due to contract build or process errors
• Ability to research and interpret payer information and policies
• Extensive experience working with Trizetto’s EOBresolve tool or equivalent contract management software preferred
• Experience working with Athenahealth’s suite of tools preferred
• Analytical skills and advanced Excel skills (ex: pivot tables, VLOOKUP, sort/filtering and formulas)
• Must comply with HIPAA rules and regulations
• Excellent written and verbal communication
• Great time and project management skills
• Ability to prioritize and escalate issues as appropriate
• Ability to work independently and multi-task in a fast paced environment

 

The salary range for this role is $75,000.00-$88,000.00 in base pay and exclusive of any bonuses 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% and restricted stock units. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

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. We understand that healthcare is local and we are better 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.