Revenue Integrity Training Specialist

Job Responsibilities:

• Research and develop written procedures for internal RCM teams and cross-functional needs to maintain process standards.
• Design training plans for new employees and document all workflow processes, adapting methods to achieve expected improvements.
• Conduct monthly payer audits, charge alerts, and downcoding in compliance with policies to ensure accurate reimbursement and optimal revenue.

Audit and Revenue Management:

• Make independent decisions on audit results and communicate with teams to address revenue opportunities and leakage.
• Identify and monitor denial trends, assist with Trizetto/Cognizant setup, and address Salesforce cases promptly to support cash flow.
• Perform Care Center payment performance audits, track outcomes, and provide feedback to RCM leadership through quality audits.

Qualifications and Skills:

• 3+ years in medical billing and experience with payer contracts or auditing payments, with knowledge of AthenaOne and Trizetto being advantageous.
• Highly analytical with the ability to identify payment variances and resolve errors, plus skills in process documentation and training design.
• Organized team player with intermediate Excel knowledge, strong problem-solving skills, and compliance with HIPAA regulations.

Work Environment:

• Role includes remote or hybrid arrangements with technical requirements for internet speed and reimbursement for home office expenses.
• Privia Health fosters an inclusive culture that values diversity and encourages bringing your whole self to work, reflecting the communities served.