Manager, Revenue Integrity

Under the direction of the Sr. Director the Manager Revenue Integrity is responsible for processing complete accurate and timely payment audits across all markets utilizing the Trizetto / Cognizant application as well as Care Center payment performance audits upon request from Performance Management. The Manager RI is also responsible for maintaining Privias day-to-day relationship with our Trizetto / Cognizant Account Manager. Additionally they are to track and report the outcomes of both standard payer audits and requested Care Center audits. They are to review and respond to daily correspondence from internal / external customers in a timely manner and provide information as requested or properly authorized. This position works collaboratively with management and staff and routinely follows accepted safety practices.

• Nationally manage signed contracts and fee schedules / rates; create and load within Privias contract system (Trizetto / Cognizant) and update the Master Tracker by market / payer
• Audit payor processed claims; ensure reimbursement by payer is accurate per payor contract agreements government and state rates Nationally
• Lead initiatives to drive efficiency and partner internally and externally to deliver expected results; monthly market meetings with leadership internal team meetings and with top commercial payers etc
• Makes independent decisions regarding audit results communicates with appropriate teams; contract negotiators senior leaders market leaders and / or directly with the payer to ensure optimal revenue opportunity
• Create follow and ensure adherence to approved escalation processes to timely issue resolution and completion of action plans
• Assist senior leaders in projects / urgent audits or care center / provider concerns
• Identify monitor and manage denial management; identify trends work closely with our Revenue Cycle Team by market and / or payer representatives and create one pagers / reference tools on payer policies
• Assists with analysis on contract / payer issues for new contract negotiations
• Provide management guidance and training to staff and other team members as needed
• Other duties as assigned

Qualifications :

The salary range for this role is $75000.00-$88000.00 in base pay and exclusive of any bonuses 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 15% and restricted stock units. 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

Key Skills

ASC 606,Hotel Experience,Hospitality Experience,GAAP,Accounting,Revenue Management,Pricing,Analysis Skills,Salesforce,SOX,ERP Systems,NetSuite

Experience : years

Vacancy : 1