RCM Case Management Specialist

Under the direction of the Associate Director or Manager of Revenue Cycle
Management the Accounts Receivable (AR) Case Management Specialist is
responsible for ensuring the accurate and timely processing of all claims concerns or
claim projects. This role acts as a bridge between financial accuracy and efficient
communication promptly addressing daily correspondence from physicians care
centers vendors and internal teams to resolve insurance claim denials. By leveraging
Salesforce case management workflows the AR Manager ensures that all claim issues
or questions escalating to the RCM team are tracked managed and resolved with
accountability.

Primary Job Duties
Manage the full cycle of Salesforce cases ensuring all RCM-related inquiries are
documented categorized and resolved within established Service Level
Agreements (SLAs).
Monitor Salesforce dashboards to identify practice inquiries trends and report on
case resolution efficiency to leadership.
Deep expertise in billing AR follow up and denial management to promote one
touch resolution of escalated cases.
Make independent decisions regarding claim adjustments resubmissions and
other advanced resolution techniques in accordance with company policies and
best practices.
Collaborate with internal teams and care center staff to streamline workflows and
resolve escalated billing hurdles.
Utilize the Trizetto to perform denial analysis and initiate requests to add rules or
edits to prevent recurring errors.
Work directly with practice consultants or physicians to ensure optimal revenue
cycle functionality and drive department Key Performance Indicators (KPIs).
Other duties as assigned.

Qualifications :

• Education: High School Graduate.
• 3 years in a medical billing office or equivalent claims experience.
• Advanced Microsoft Excel skills (e.g. pivot tables VLOOKUP formulas) preferred.
• Experience with athenaHealth/athenaOne and Salesforce (specifically Case Management) is highly preferred
• Must understand the drivers of revenue cycle performance and be able to resolve complex multi-layered claim issues.
• Must strictly comply with all HIPAA rules regulations and company policies regarding information privacy.

The salary range for this role is $to $in base pay and exclusive of any bonus 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 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.  

Remote Work :

Yes

Employment Type :

Full-time