Medical Claims Billing Specialist (Athena)

Privia Health is a technology-driven physician enablement company providing cloud-based platforms and operational support to improve practice performance and patient outcomes. The Medical Claims Billing Specialist (Athena) / AR Manager role focuses on accurate claims processing and resolving escalated revenue cycle and denial issues to support optimal reimbursement and KPI attainment.

• Manage accounts receivable (AR), including aged AR analysis, identifying root causes, and creating rules to prevent recurring errors.
• Investigate, resolve, and appeal claim denials, including communicating with payer representatives as needed.
• Make independent decisions on claim adjustments, resubmissions, appeals, and other resolution actions.
• Respond to daily correspondence from physician practices and handle incoming Salesforce cases by providing authorized information and timely resolution.
• Collaborate with internal teams (Performance, Operations, Sales) and care center staff to resolve claim and revenue cycle issues.
• Support large care center go-lives, which may require overnight travel.
• Partner with the Revenue Optimization team to help ensure reimbursement aligns with payer contract agreements and perform denial analysis using the TriZetto platform.
• Work directly with practice consultants and/or physicians to improve revenue cycle functionality.
• Drive achievement of daily and monthly departmental KPIs using a team-focused approach.
• Perform other duties as assigned.

• Education: High School Graduate.

• Experience: 3+ years in a physician medical billing office.

• Preferred: Medicare Advantage and USDOL experience; experience with major payers (e.g., Anthem, Medicare/Medicaid, United Healthcare, Carefirst); Athena EHR experience.

• Skills: Ability to investigate and resolve complex claims and denial trends; strong revenue cycle knowledge.

• Tools: Advanced Microsoft Excel and Google Sheets skills (e.g., pivot tables, VLOOKUP, formulas, sort/filtering).

• Compliance: Must comply with HIPAA rules and regulations.

• Pay: $24.45/hr to $26.45/hr base pay; eligible for annual bonus targeted at 10%.

• Benefits: Medical, dental, vision, life, and pet insurance; 401(k); paid time off; wellness programs.

• Travel: May include overnight travel to support care center go-lives.

• Remote technical requirement (if working remotely): Minimum 5 Mbps download and 3 Mbps upload internet speed; eligible for expense reimbursement for home office internet costs where applicable.

• Other: Pay determined based on factors such as experience, education, and geographic location.