Conduct audits of payer contracts, government fee schedules, and care center payments to ensure accurate reimbursement and maximize cash flow.
Identify and manage denial trends, working closely with Revenue Cycle Teams and payer representatives to resolve issues and create reference tools.
Assist with system setup, address cases in Salesforce and athenaOne, and perform other duties focused on key departmental performance goals.
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.
Identify and resolve revenue leakage by ensuring data integrity across revenue cycle management and provider credentialing systems.
Maintain and validate enrollment tables and system configurations, and optimize EHR rules to prevent claim denials.
Develop reports and dashboards to track KPIs and collaborate cross-functionally to resolve data and workflow issues.
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. It is led by top industry talent and consists of scalable operations and cloud-based technology aimed at reducing healthcare costs and improving outcomes.
Ensure the timely and accurate payment or denial of claims while meeting regulations, agreements, and policies.
Audit complex Medicare and Medi-Cal claims to impact financial integrity, regulatory adherence, and provider trust.
Collaborate with leadership to identify trends, mitigate risk, and drive process improvements across claims operations.
WelbeHealth serves vulnerable seniors through shared intention, pioneering spirit, and courage to love. They are a participant-focused organization with a commitment to diversity, equity, and inclusion, operating as an equal opportunity employer.
Manage the standard credentialing review process for pharmacies.
Review exclusion lists to identify any excluded pharmacies.
Manage the development and maintenance of a credentialing database.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. They have solutions such as Capital Rx and Judi® which consolidates all claim administration-related workflows in one scalable, secure platform.