Manager, Revenue Integrity

Privia Health

2d•$75,000 - $88,000

About The Position

Under the direction of the Sr. Director, the Manager, Revenue Integrity is responsible for processing complete, accurate and timely payment audits across all markets utilizing the Trizetto/Cognizant application, as well as Care Center payment performance audits, upon request from Performance Management. The Manager, RI is also responsible for maintaining Privia’s day-to-day relationship with our Trizetto/Cognizant Account Manager. Additionally, they are to track and report the outcomes of both standard payer audits and requested Care Center audits. They are to review and respond to daily correspondence from internal/external customers in a timely manner, and provide information as requested or properly authorized. This position works collaboratively with management and staff and routinely follows accepted safety practices. Nationally manage signed contracts and fee schedules/rates; create and load within Privia’s 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 Provide management, guidance and training to staff and other team members as needed Other duties as assigned

Requirements

High School Graduate, Medical Office training certificate or equivalent
Experience: 5+ years experience in auditing, preferrably within revenue cycle
3+ years of people management experience required
Strong analytical and reporting skills required
Experience interpreting contract language and identifying payment variance due to contract build or process errors
Ability to research and interpret payer information and policies
Analytical skills and advanced Excel skills (ex: pivot tables, VLOOKUP, sort/filtering and formulas)
Must comply with HIPAA rules and regulations
Excellent written and verbal communication
Great time and project management skills
Ability to prioritize and escalate issues as appropriate
Ability to work independently and multi-task in a fast paced environment

Nice To Haves

Experience managing offshore resources preferred
Extensive experience working with Trizetto’s EOBresolve tool or equivalent contract management software preferred
Experience working with Athenahealth’s suite of tools preferred

Responsibilities

Processing complete, accurate and timely payment audits across all markets utilizing the Trizetto/Cognizant application
Maintaining Privia’s day-to-day relationship with our Trizetto/Cognizant Account Manager
Tracking and reporting the outcomes of both standard payer audits and requested Care Center audits
Reviewing and responding to daily correspondence from internal/external customers in a timely manner, and provide information as requested or properly authorized
Nationally manage signed contracts and fee schedules/rates; create and load within Privia’s 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
Provide management, guidance and training to staff and other team members as needed
Other duties as assigned