Revenue Integrity Training Specialist

We are seeking a highly motivated and detail-oriented Revenue Integrity Training Specialist to join our team. This dual-role position is crucial for maintaining the financial health of our regional operations by ensuring accurate charging, billing, and coding practices. The ideal candidate will possess a strong background in healthcare revenue cycle, auditing, documentation, training and process improvement. The specialist will be responsible for conducting rigorous audits to identify and resolve payment discrepancies and denial trends, while simultaneously developing standard operating procedures (SOPs) and training new team members to uphold best practices across the region.

Primary Job Duties:

• Research, develop and maintain concise written procedures and processes for internal RCM team(s), cross-functionally when needed.
• Design training plans for new Privians, both within and outside of RCM Optimization.
• Develop and document all workflow processes and procedures adhering to best practice standards.
• Develop alternative training methods if expected improvements are achieved
• Complete monthly payer and fee schedule audits, charge alerts and downcoding in compliance with Privia policies, payer contracts and government fee schedules.
• Ensure reimbursement by payer is accurate.
• Make independent decisions regarding audit results, communicate with appropriate teams to ensure optimal revenue opportunity.
• Identify, monitor and inform the RCM team of denial trends creating revenue delays and leakages.
• Assist with Trizetto/Cognizant setup, fee schedule setup.
• Work and address Salesforce cases in a timely manner.
• Address requests for Care Center payment performance audits to assist in maximizing cash flow, as well as, tracking and reporting the outcomes of both scheduled payer audits and requested Care Center audits.
• Evaluate training progress and competency by conducting routine quality audits, providing meaningful feedback to RCM leadership
• Coordinate all aspects of training activities
• Special projects and other duties as assigned, focused on key performance and department goals.