Medical Claims Billing Specialist

About Privia Health

Privia Health™ is a national, technology-driven company aimed at empowering physicians by partnering with medical groups, health plans, and systems to enhance practice performance, improve patient care experiences, and incentivize providers for delivering high-quality care both in-person and virtually. The company's platform features cloud-based technology combined with expert physician leadership and scalable operations that work to reduce unnecessary healthcare expenses, promote better health outcomes, and support the wellness of medical providers.

Position Overview

This hybrid full-time role requires attendance at the Houston office located at 1200 Binz St Suite 1490 on Tuesdays and Thursdays. The other weekdays, Monday, Wednesday, and Friday, are typically remote but may require in-office presence for meetings, training, or conferences.

Reporting to the Manager of Revenue Cycle Management, the Medical Claims Specialist is accountable for accurate, complete, and timely processing of medical claims. Responsibilities include managing and resolving claim denials, responding promptly to daily correspondence from physician practices, addressing incoming SalesForce queries, and coordinating with the Revenue Cycle Management team to resolve escalated claim issues.

Key Responsibilities

• Investigate reasons for claim denials, resolve issues, and pursue appeals including liaison with payers as needed.
• Make independent determinations for claim adjustments, resubmissions, and appeals to resolve discrepancies.
• Collaborate effectively with internal teams such as Performance, Operations, and Sales, as well as directly with care center personnel.
• Partner with the Revenue Optimization team to ensure reimbursements align with contractual agreements.
• Work closely with practice consultants and physicians to optimize revenue cycle processes.
• Drive team efforts to meet daily and monthly Key Performance Indicators (KPIs) towards department objectives.
• Perform additional duties as assigned.

Required and Preferred Qualifications

• Minimum education: High school diploma.
• At least 3 years of experience in medical claims processing within a physician billing office.
• Strong understanding of revenue cycle management principles and ability to handle complex claims resolution.
• Proficiency in Microsoft Excel, including advanced functions such as pivot tables, VLOOKUP, and formula usage preferred.
• Familiarity with Explanation of Benefit (EOB) statements is required.
• Experience with Google Suite and Athena EMR is advantageous.
• Access to a private, quiet workspace with high-speed internet (minimum 5 Mbps download and 3 Mbps upload) for remote work days is essential.
• Comfortable with public speaking and mentoring others.
• Excellent written and verbal communication skills.
• Self-motivated with strong time management and multitasking capabilities in fast-paced settings.
• Analytical thinker with problem-solving skills and independent decision-making ability.
• Compliance with HIPAA regulations is mandatory.

Compensation and Benefits

This position offers an hourly base wage ranging from $24 to $26.45, exclusive of bonuses and benefits. Additional benefits include medical, dental, vision, life and pet insurance, 401(k), paid time off, and wellness programs. An annual bonus targeted at 10% based on individual performance is also available. Salary within the range is determined by experience, education, and location.

Additional Information

All applicant information will be handled confidentially per Equal Employment Opportunity guidelines.

Technical Requirements for Remote Work: Employees who work remotely must have internet connectivity with at least 5 Mbps download and 3 Mbps upload speeds. Internet speed verification prior to employment is required, and expense reimbursement for home office internet costs is available for qualifying employees.

Privia Health fosters an inclusive workplace culture and encourages applicants regardless of age, race, disability, gender identity or any other legally protected status.