Role Description Under the direction of the Director or Manager of Revenue Cycle Management, the Medical Claims Billing Specialist (Accounts Receivable (AR) Manager) is responsible for complete, accurate and timely processing of all designated claims, reviewing and responding to daily correspondence from physician practices in a timely manner, answering incoming SalesForce cases and providing information as requested or properly authorized. The AR Manager will take steps necessary to resolve all claim issues or questions that escalate to the RCM team. Resolution of SalesForce cases and management of issues and the team resolving the cases is a key element in this role. - Management of the accounts receivable (AR) including analysis of the aged AR, looking for root cause issues; writing rules where appropriate to stop errors from occurring. - Denial management - investigating denial sources, resolving and appealing denials which may include contacting payer representatives. - Makes independent decisions regarding claim adjustments, resubmission, appeals, and other claim resolution techniques. - Collaborate internal teams (Performance, Operations, Sales) as well as care center staff when appropriate. - At times, support large care center go lives which may include overnight travel. - Works closely with our Revenue Optimization team, to support efforts to ensure reimbursement is in line with payer contract agreements. Performs Denial analysis utilizing the Trizetto platform. - Work directly with practice consultants or physicians to ensure optimal revenue cycle functionality. - Drive toward achievement of department’s daily and monthly Key Performance Indicators (KPIs), requiring a team focused approach to attainment of these goals. - Other duties as assigned. Qualifications - High School Graduate - 3+ years experience in a physician medical billing office - Athena EHR experience highly preferred - CareFirst MD experience highly preferred - Medicare Advantage & USDOL experience preferred - Experience with major payers such as Anthem, Medicare/Medicaid, United Healthcare, Carefirst also preferred. - Must understand the drivers of revenue cycle optimal performance and be able to investigate and resolve complex claims & denial trends. - Advanced Microsoft Excel & Google Sheets skills (e.g., pivot tables, VLOOKUP, sort/filtering, formulas) and proficiency in Google Sheets preferred - Must comply with HIPAA rules and regulations Requirements - The hourly range for this role is $24.45/hr to $26.45/hr in hourly base pay and exclusive of any bonuses 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 10%. - The base pay offered will be determined based on relevant factors such as experience, education, and geographic location. Benefits - Expense reimbursement for remote workers to offset internet costs. Company Description Privia Health™ is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.

• Deliver prompt and accurate claims service to policyholders and agents for both multi-peril crop insurance (MPCI) and crop hail claims • Complete field inspections, communicating with involved parties, performing investigations, determining appropriate adjustments • Partner with Field Claims Manager to ensure effective and efficient claims operations • Accurately document, process and transmit loss information • Provide overflow support to Compliance Department of quality control audits for Federal Crop Insurance Corporation (FCIC and Crop Hail) • Build and maintain relationships with customers by providing timely and accurate policy service • Coach claims adjusting team by supporting and mentoring team members

• Provide technical guidance and analysis for complex and high-value claims • Assist in implementing and maintaining claims management strategies • Maintain comprehensive knowledge of insurance guidelines and policies • Build and maintain relationships with stakeholders • Manage a portfolio of complex or high-value claims • Act as an escalation point for customer complaints • Provide senior technical expertise and mentoring for team development • Engage with the team to encourage partner relationships • Support process improvement through negotiation and dispute resolution

• Under general supervision, assesses claim information, references contracts and performs calculations and other functions to accomplish the processing and payment of insurance claims of a complicated or non-routine nature • Interprets contract information and communicates with outside parties to obtain information and coordinate coverage • Performs claim research and adjustments • Successfully completes all training programs as required for the level • Processes claims for two products or claim types (dental, hospital, medical, ITS, FEP) • Responds to written inquiries from internal and external customers as business needs dictate