Jobs at Privia Health

Manage and resolve unapplied cash, unidentified payments, and unpostable records in the revenue cycle. Reconcile re-adjudicated claims, make claim adjustments/resubmissions, maintain payer portal access, train internal teams, work with practice consultants, and meet daily/monthly KPIs. Use Salesforce case management and athenaOne workflows.

Manage and train revenue cycle staff, oversee claims submission and AR resolution, analyze denial patterns, lead payer and care center projects, resolve escalations and Salesforce cases, enforce RCM policies, support go-lives, and drive KPI attainment.

Manage accounts receivable and denial resolution for neurology practices: analyze aged AR, investigate and appeal denials, collaborate with internal teams and practices, support go-lives, use Trizetto and Salesforce, and meet departmental KPIs.

Audit payer-processed claims and care center payment performance to ensure accurate reimbursement per contracts and fee schedules. Perform payer payment audits, denial trend analysis, fee-schedule and system setup (Trizetto/Cognizant), manage escalations, coordinate with revenue cycle teams and payers, and track/report audit outcomes while ensuring HIPAA compliance.

Deliver risk-adjustment and coding education (HCC, ICD-10-CM, CPT, HCPCS), conduct prospective and retrospective chart audits, analyze coding performance, generate audit reports, lead provider trainings, ensure CMS/AMA compliance, and support documentation improvement initiatives.

Audit medical records for coding compliance (CPT, ICD-10, HCPCS), prepare audit reports, provide provider education and training, interpret federal/state CMS/Medicare regulations, and support coding issue resolution and documentation improvement.

The Coding Compliance Audit & Education Specialist audits medical records for compliance, educates providers on coding guidelines, and prepares audit reports. They conduct trainings, communicate findings, and provide consultation to ensure compliance with federal regulations.