Sr Manager Revenue Integrity
Sr Manager Revenue Integrity
Employer Active
Job Alert
You will be updated with latest job alerts via email
Share
Job Alert
You will be updated with latest job alerts via email
Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Lead and manage a team of revenue integrity specialists responsible for national audits focused on underpayment recoveries and billing accuracy
Nationally manage signed contracts and fee schedules/rates; create and load within Privias contract system (Trizetto/Cognizant) and update the Master Tracker by market/payer
Audit payor processed claims; ensure reimbursement by payer is accurate per payor contract agreements government and state rates Nationally
Lead initiatives to drive efficiency and partner internally and externally to deliver expected results; monthly market meetings with leadership internal team meetings and with top commercial payers etc
Makes independent decisions regarding audit results communicates with appropriate teams; contract negotiators senior leaders market leaders and/or directly with the payer to ensure optimal revenue opportunity
Create follow and ensure adherence to approved escalation processes to timely issue resolution and completion of action plans
Assist senior leaders in projects/urgent audits or care center/provider concerns
Identify monitor and manage denial management; identify trends work closely with our Revenue Cycle Team by market and/or payer representatives and create one pagers/reference tools on payer policies
Assists with analysis on contract/payer issues for new contract negotiations
Serve as a coach to peers and team members and act as a resource for escalated issues
Provide management guidance and training to staff and perform duties of subordinate staff as needed
Responsible for staffing to include hiring termination coaching and training
Provide ongoing feedback to subordinate staff regarding performance throughout the year
Coordinate and communicate with third party vendor partners as needed
Other duties as assigned
Qualifications :
- High School Graduate Medical Office training certificate preferred
- 5 years experience in a medical in medical billing office or equivalent claims experience preferred
- 5 years with payer contracts (language) and/or auditing payer payments
- Must be analytical identify payment variance due to contract build or process errors resolve payment issues track & analyze payer information/policies.
- Excel functions (minimum: VLOOKUP pivot tables sort/filtering and formulas)
- Experience working in Trizetto EOB resolve tool or equivalent use of contract management/software
- Experience working with athenahealths suite of tools is preferred
- Must comply with HIPAA rules and regulations
- Excellent written and verbal communication
- Experience in a people management function (internal/ external customers and levels of senior leaders)
- Willingness to train and mentor other team members
- Great time management skills (organized and the ability to manage multiple projects while producing exceptional work. Appropriate approach for duties recognizing priorities reporting and escalating issues and ideas through the appropriate chain of command)
- Ability to work independently and multitask in a fast paced environment
The salary range for this role is $80000 to $85000 in base pay and exclusive of any bonus or benefits (medical dental vision life and pet insurance 401K paid time off and other wellness programs). This role is also eligible for an annual bonus targeted at 15% based on performance in the role. The base pay offered will be determined based on relevant factors such as experience education and geographic location.
Additional Information :
All your information will be kept confidential according to EEO guidelines.
Technical Requirements (for remote workers only not applicable for onsite/in office work):
In order to successfully work remotely supporting our patients and providers we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.
Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. Privia is a better company when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age color national origin physical or mental (dis)ability race religion gender sex gender identity and/or expression marital status veteran status or any other characteristic protected by federal state or local law.
Remote Work :
Yes
Employment Type :
Fulltime
Employment Type
Remote
Company Industry
Key Skills
- ASC 606
- Hotel Experience
- Hospitality Experience
- GAAP
- Accounting
- Revenue Management
- Pricing
- Analysis Skills
- Salesforce
- SOX
- ERP Systems
- NetSuite
