Lab Medical Claims Biller - Houston, TX

*This full-time position is a hybrid role that requires working in the office on Tuesdays and Thursdays at 1200 Binz St Suite 1490 Houston TX 77004. Mon, Wed, and Fri are typically work from home but may be in office on occasion.*

We seek a highly organized Ancillary AR Manager (medical claims biller) with years of experience in the healthcare industry, specifically laboratory medicine. Under the direction of the Manager of Revenue Optimization & Training, the Ancillary AR Manager is responsible for ensuring the accurate and timely processing of all claims for our Lab Ancillary. This role includes promptly addressing daily correspondence from physician practices, reviewing and appealing insurance claim denials, and following up on aged claims. The Ancillary AR Manager will review monthly and weekly accounts receivable dashboards, with a strong focus on identifying opportunities for improvement and developing a plan to implement necessary changes to meet performance expectations.

Primary Job Duties:​​​​​​

• Manage the accounts receivable (AR), including analysis of the aged AR, identifying root cause issues, and suggesting billing rules/edits when appropriate to prevent errors and mitigate insurance denials.
• Maintain current knowledge of payer regulations, including ICD-10 and CPT codes.
• Analyze billing metrics to report on performance impacts and identify opportunities for improvement.
• Responsible for organizing and leading projects, and presenting in front of groups
• Denial management - investigate denial sources, resolve and appeal denials which may include contacting payer representatives
• Drive toward achievement of department’s daily and monthly Key Performance Indicators (KPIs)
• Maintain Clinical Decision Support ( CDS ) Tool for Lab Orders
• Must comply with HIPAA rules and regulations
• Perform other duties and special projects as assigned

• High School Graduate
• Experience in laboratory billing, billing software, EDI enrollment, and payer portals required
• 5+ years experience in a medical billing office or equivalent claims experience
• Must understand the drivers of revenue cycle optimal performance and be able to investigate and resolve complex claims
• Advanced Microsoft Excel skills (ex: pivot tables, VLOOKUP, sort/filtering, formulas) preferred
• Experience with athenaHeath and/or athenaOne preferred
• Experience with Trizetto and/or Microstrategy preferred
• Expert at managing multiple priorities effectively and efficiently
• The ability to effectively work with other departments to resolve problems. Must have interpersonal skills to gain cooperation with other departments, and foster continuous improvements.
• Critical thinking skills to make independent decisions regarding claims adjustments, resubmissions, appeals, and other claim resolution techniques

The salary range for this role is $55,000 to $60,000 in base pay. This role is also eligible for an annual bonus targeted at 10% based on performance in the role. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

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. Privia is a better company 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.