Medical Claims Billing Specialist (Unpostables)

Under the direction of the Sr. Manager, Unpostables of Revenue Cycle Management, the Accounts Receivable (AR) Manager - Unpostables is responsible for complete, accurate and timely processing of all designated claims, reviewing and responding to daily correspondence from physician practices in a timely manner, answering incoming telephone calls or SalesForce cases and providing information as requested or properly authorized. Looking for strong follow up skills, attention to detail, a solutions focused mindset, and a driving work ethic. This position works collaboratively with the staff in physician practices as well as team members at Privia Headquarters. Primary Job Duties:Unpostables management-researching and resolving records that have not been matched to athenaNet related charges (including insurance payments, capitation payments, patient payments, remittance items and voided charges). Reconciliation of re-adjudicated claims/payer takebacks. Management of the accounts receivable (AR) including analysis of the aged AR, looking for root cause issues; writing rules where appropriate to stop errors from occurring. Denial management, investigating denial sources, resolving and appealing denials which may include contacting payer representatives. Makes independent decisions regarding claim adjustments, resubmission, appeals, and other claim resolution techniques. Maintain web portal access for all payers and interface with Athena to update the master list of portal addresses for the Athena database. Makes policy updates as needed, to all RCM policies. Responsible for training internal teams (Operations, Sales) as well as care center staff when appropriate and working directly with practice consultants or physicians to ensure optimal revenue cycle functionality. Laser focused drive toward achievement of department’s daily and monthly Key Performance Indicators (KPIs), requiring a team focused approach to attainment of these goals.