RCM Case Management Specialist Full Time

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 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 $52,000,00 to $55,000,00 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 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.