Revenue Integrity Specialist - Remote

Overview

The Revenue Integrity Specialist is responsible for processing reimbursement/payment audits and ensuring compliance with Privia policies and payer contracts. This role collaborates with various teams to maximize cash flow and improve payment performance.

In Short

• Conduct reimbursement audits and ensure accuracy according to contracts.
• Perform Care Center audits post-implementation.
• Assist in driving efficiency initiatives with leadership.
• Make independent decisions on audit results.
• Manage denial trends and create reference tools.
• Work with Salesforce cases and athenaOne tables.
• Adhere to escalation processes for timely resolution.
• Identify and resolve payment issues.
• Collaborate with Revenue Cycle Teams and payer representatives.
• Other duties as assigned to meet department goals.

Requirements

• High School Graduate.
• Advanced skills in Microsoft Excel.
• 3+ years of experience with payer contracts and auditing.
• Analytical skills to identify payment variances.
• Experience with Trizetto EOB resolve tool or equivalent.
• Preferred experience in a medical billing office.
• Familiarity with athenaOne software system.
• Compliance with HIPAA regulations is required.

Benefits

• Base salary of $55,000 to $60,000.
• Annual bonus targeted at 15% based on performance.
• Comprehensive benefits including medical, dental, and vision.
• 401K and paid time off.
• Wellness programs available.