Job Description

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.

Job Description

Under the supervision of the Privia+ Manager, the CODER+ Specialist is responsible for complete, accurate, and timely processing of all designated claims, reviewing and responding to daily correspondence, customer service activities, and providing information as requested or properly authorized. The ideal candidate possesses excellent and professional communication skills, strong follow up support, attention to detail, and takes pride in successfully resolving issues. This position works collaboratively with the staff in care centers, as well as team members at Privia+, and Privia as a whole.

Primary Job Duties:

• Analyzing medical records to identify services performed in order to convert documentation into CPT codes and appropriate diagnosis codes.
• Investigate front end scrub edits to ensure clean claims submission to prevent increased back-end coding denials.
• Independently file corrected claims with coding corrections to the insurance
• Liaising with providers and other parties to clarify information
• Research and answer Coder+ questions where appropriate and deliver instructions to the providers and practice staff.
• Abide by the standard of Ethical Coding practices set by AHIMA, AMA, CMS, etc.
• Assist with Salesforce case management requiring Coding Reviews
• Query the provider when there is documentation clarification preventing coding assignment
• Communicate to leadership identified trends and documentation opportunities
• Monitor and respond to email 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
• Upholding patient privacy and adhering to regulations such as HPIAA
• Clean-up projects for escalated care centers
• Other duties as assigned

Qualifications

• High School diploma, Medical Office training certificate or relevant experience preferred
• Claim and denials management experience required
• 3+ years of experience in PB and other coding specialties
• Must be a Certified Professional Coder (CPC)
• 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 $63,000 to $70,000.00  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%. 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.

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