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Primary Job Duties:
- Reimbursement Audits: Conduct audits of payer processed claims to verify accurate reimbursement per payer contract agreements.
- Care Center Implementation Audits: Conduct post-implementation Care Center audits following the audit policy.
- Strategic Initiatives: Assist the Manager, RI, in leading initiatives that drive efficiency.
Decision Making & Communication:
- Make independent decisions regarding audit results and communicate these findings with appropriate teams.
- Escalation Management: Create, follow, and ensure adherence to approved escalation processes for timely issue resolution.
- Denial Management: Identify, monitor, and manage denial management trends.
Privia Health
Privia Health is a technology-driven physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices. Their platform consists of scalable operations and cloud-based technology to reduce healthcare costs and improve patient outcomes.