Primary Responsibilities:
- Audit new provider and care center information across systems for accuracy and ensure reimbursement aligns with payer contracts and government rates.
- Conduct Care Center audits post-implementation and assist in leading efficiency initiatives through internal and external meetings.
- Make independent decisions on audit results and communicate with teams and payers to resolve issues and optimize revenue.
Qualifications and Skills:
- High School Graduate with 3+ years of experience in payer contracts, auditing, or medical billing, and advanced Microsoft Excel skills.
- Strong understanding of fee schedules, claims payment, and analytical skills to identify payment variances and process errors.
- Experience with Trizetto EOB resolve tool or equivalent contract management software, with athenaOne system experience preferred.
Work Environment and Compensation:
- This full-time role offers a base salary range of $60,000-$65,000 per year, plus an annual bonus target of 10%, based on experience and location.
- Benefits include medical, dental, vision, life, and pet insurance, 401(k), paid time off, and wellness programs.
- The position supports remote or on-site work in the US, with technical requirements for remote workers and a commitment to an inclusive, diverse workplace.
Privia Health
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices and improve patient care. The company is led by top industry talent and physician leadership, featuring scalable operations and cloud-based technology to reduce healthcare costs and improve outcomes.