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 Job 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. Primary Job Duties: - 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 - OBGYN billing experience highly preferred - Athena EHR experience highly preferred - CareFirst MD experience 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 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. 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 https://www.speedtest.net/. 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. We understand that healthcare is local and we are better 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. - Department: Revenue Cycle

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 Job 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. Primary Job Duties: - 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 required - OBGYN billing experience preferred - CareFirst MD experience 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 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. 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 https://www.speedtest.net/. 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. We understand that healthcare is local and we are better 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. - Department: Revenue Cycle

Role Description Provides investigative support for special investigation unit (SIU) activities specific to medical provider coding fraud, waste and abuse (FWA). Investigates and resolves instances of health care fraud and abuse investigations of medical providers using informational tips from member benefits and medical records following review of post-payment claims. - Independently re-evaluates medical claims and associated records by applying knowledge of advanced coding, all relevant and applicable Federal and State regulatory requirements, and Molina policies. - Reviews post-pay claims against corresponding medical records to determine accuracy of claims payments. - Manages documents and prioritizes caseloads to ensure timely turnaround. - Ensures adherence to applicable state/federal/internal policies, Current Procedural Terminology (CPT) guidelines and provider contract requirements. - Devises clinical summary post-review. - Communicates and participates in meetings related to cases. - Completes medical review to facilitate referral to law enforcement or payment recovery. - Supports investigation work as necessary and required by the regulatory agency. Qualifications - At least 2 years CPT coding experience in a surgical, hospital and/or clinic setting, or equivalent combination of relevant education and experience. - Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Professional Medical Auditor (CPMA), or American Academy of Professional Coders (AAPC) certified. - Critical-thinking, problem-solving and analytical skills. - Ability to prioritize and manage multiple tasks. - Ability to work in a team setting. - Strong verbal/written communication skills, and presentation skills. - Microsoft Office suite (including Excel), and applicable software program(s) proficiency. - In some states, 5 years of experience working in a fraud, waste and abuse (FWA)/special investigations unit (SIU)/fraud investigations role may be required (dependent on state/contractual requirements). - Knowledge of investigative and law enforcement procedures with emphasis on fraud investigations. - Knowledge of Managed Care and the Medicaid, Medicare, and Marketplace programs. - Understanding of claim billing codes, medical terminology, anatomy, and health care delivery systems. - Ability to research and interpret regulatory requirements. Preferred Qualifications - Certified Professional Compliance Officer (CPCO). - Certified Fraud Examiner (CFE) and/or Accredited Health Care Fraud Investigator (AHFI). - Experience working in group health insurance, particularly within claims processing or operations. - Working knowledge of local, state and federal laws and regulations pertaining to health insurance, investigations and legal processes (commercial insurance, Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy, etc.). - Experience with claims processing systems. - Ability to use Microsoft Excel/Access platforms working with large quantities of data. - Ability to answer questions, identify trends and patterns, and present findings. Benefits Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

• Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. • Code and abstract highly complex clinical information from high-acuity inpatient charts or outpatient surgery and observation charts for reimbursement, research and compliance with federal regulations and other agencies, utilizing established coding principles and protocols. • Identify, review, and assign highly complex/high-acuity codes, including ICD-10-CM, PCS, POA and PSI indicators for inpatient charts. • Identify, review and assign highly complex codes, including ICD-10-CM and CPT for ambulatory surgery and observation charts. • Clarify highly complex discrepancies in documentation and coding. • Ensure accuracy and timeliness of highly complex/high acuity coding/abstracting for inpatient and outpatient charts to expedite the billing process and to facilitate data retrieval for physician access and ongoing patient care. • Leverage AI tools to enhance quality and productivity and reduce manual effort in routine tasks. • Monitor performance and accuracy of AI-assisted outputs, ensuring alignment with quality standards and coding guidelines.