Coding & Billing Claims Specialist (CPC)

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

Under the supervision of the CODER/BILLER+ Program Manager, the Biller+ AR Manager is responsible for complete, accurate, and timely processing of all designated claims, reviewing and responding to daily correspondence from physician practices, answering incoming telephone calls, and providing information as requested or properly authorized. This person will assist in Coder/Biller+ go-live training as well as communicate closely with providers and practice staff. The ideal candidate possesses strong follow up skills, attention to detail, and takes pride in successfully resolving issues. This position works collaboratively with the staff in our physician practices as well as team members at Privia.

Primary Job Duties:

• HOLD and Denial Management:

  • Investigate denial sources; resolve and appeal HOLDs / Denials, which may include contacting payer representatives.

  • Independently decide how to adjust claims, including resubmission, appeals, and other claim resolution techniques.

• Assist in performing CODER/BILLER+ trainings in collaboration with market RCM teams.

• Research and answer BILLER+ claim HOLD questions; deliver instructions to the providers and practice staff.

• Manage Salesforce cases

  • Route claims to the appropriate owner

  • Manage all Biller+ cases

  • Manage all Coder+ cases

    • Serves as the primary escalation point by working with the vendor to resolve coding issues and relaying resolutions to the care center

• Monitor and respond to emails timely

• Follow guidelines and legal requirements to ensure compliance with federal and state regulatory bodies.

• Collaborate with Success Management on Check-in meetings for overall program success and client satisfaction

  • Provide HOLDs breakdown and aging report 

  • Identify trends and solicit feedback from the Care Center to improve program success

  • Review current HOLDs in the practice worklist and set expectations

• Provide additional training sessions with the Care Center as requested 

• Clean-up projects for escalated care centers 

• High School diploma, Medical Office training certificate or relevant experience preferred

• Claim and denials management experience required 

• 3+ years of experience in medical billing office preferred 

• Must understand the drivers of revenue cycle optimal performance and be able to investigate and resolve complex claims

• Strong preference for experience working with athenaHealth’s suite of tools 

• Must provide accessibility to private, quiet work space with high-speed internet to effectively work remotely

• Must comply with HIPAA rules and regulations 

• Ability to work effectively with physicians, Non-physician practitioners (NPP), practice staff, health plan/other external parties and Privia multidisciplinary team

The salary range for this role is $55,000.00-$65,000.00 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 10% based on the performance for the role and resricted stock units. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location. 

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. Privia is a better company 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.