RCM Audit Specialist

Summary

Privia Health is a technology-driven physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices and improve patient care. The RCM Audit Specialist ensures the accuracy, efficiency, and compliance of revenue cycle processes by conducting audits, monitoring performance, identifying process improvements, and supporting claims and denial management functions.

Responsibilities

• Conduct quality reviews, audit revenue cycle claims and workflows against established standard operating procedures (SOPs)
• Develop, collect, analyze, report and measure multiple quality improvement initiatives that supports RCM operational functions
• Create and maintain quality measurements to track improvements in individual and team performance scores
• Identify potential deficiencies in processes via analysis and trends
• Create reports and deliver assessment/evaluation results to appropriate levels of leadership
• Research and identify the “root cause analysis” in process improvement (e.g. Ability to identify when a function/action was performed that is not included in the SOP or documentation available) and utilize audit findings to report trends and recommended training
• Assist with establishing, updating and communicating new and existing procedures
• Analyze and measure results of implemented policies and changes
• Collaborate with various RCM Leaders and internal partners to ensure goals are being met
• Serve as a SME on all RCM workflows that are being audited
• Participate in special projects, audits and process improvements in support of quality assurance initiatives
• Other duties, as assigned i.e. coordinate and serve as supplemental support to the National Training Team

Skills

• 3+ years experience in an auditing/QA role or equivalent RCM job related experience
• Advanced working knowledge of Google Suite: Sheets, Slides and Forms
• Advanced Excel skills to include the ability to use formulas to analyze data, create graphs and pivot tables
• Experience managing data located in multiple software systems
• Experience documenting clearly defined processes, standard operating procedures and policies
• Demonstrates effective written and verbal communication skills with the ability to self-edit
• Must demonstrate strong interpersonal skills to interact positively and effectively
• Ability to work in a very fast-paced and changing work environment
• Must comply with HIPAA rules and regulations
• Collaborative, customer-focused and able to create visible value
• Ability to prioritize tasks, use sound judgment, and remain organized
• Strong attention to detail and time management skills
• Ability to accept constructive feedback and work towards self-improvement and professional growth
• Associate's or bachelor's degree preferred
• Experience with statistical analysis preferred
• 2+ years experience with athenaHeath and/or athenaOne preferred

Qualifications

Must Haves

• 3+ years experience in an auditing/QA role or equivalent RCM job related experience
• Advanced working knowledge of Google Suite: Sheets, Slides and Forms
• Advanced Excel skills to include the ability to use formulas to analyze data, create graphs and pivot tables
• Experience managing data located in multiple software systems
• Experience documenting clearly defined processes, standard operating procedures and policies
• Demonstrates effective written and verbal communication skills with the ability to self-edit
• Must demonstrate strong interpersonal skills to interact positively and effectively
• Ability to work in a very fast-paced and changing work environment
• Must comply with HIPAA rules and regulations
• Collaborative, customer-focused and able to create visible value
• Ability to prioritize tasks, use sound judgment, and remain organized
• Strong attention to detail and time management skills
• Ability to accept constructive feedback and work towards self-improvement and professional growth

Nice to Haves

• Associate's or bachelor's degree preferred
• Experience with statistical analysis preferred
• 2+ years experience with athenaHeath and/or athenaOne preferred

Benefits

• Medical insurance
• Dental insurance
• Vision insurance
• Life insurance
• Pet insurance
• 401K
• Paid time off
• Other wellness programs
• Annual bonus targeted at 10%
• Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.