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Privia Health almost 2 years ago
location: remoteus
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Biller+ Accounts Receivable Manager

Remote, US, United States

Employees can work remotely

Full-time

Department: 250 – Revenue Cycle

Company Description

Privia Health is a national physician platform transforming the healthcare delivery experience. We provide tailored solutions for physicians and providers, creating value and securing their future.

Through high-performance physician groups, accountable care organizations, and population health management programs, Privia works in partnership with health plans, health systems, and employers to better align reimbursements to quality and outcomes.

Job Description

  • Title/Position: CODER/BILLER+ Specialist
  • Department or Business Unit: RCM
  • Reporting Structure: CODER/BILLER+ Program Manager
  • Employment Type: FTE
  • Exemption Status: EXEMPT
  • Min. Experience: Mid-Level
  • Travel Required: Yes ~5%

Overview of the Role:

Under the supervision of the CODER/BILLER+ Program Manager, the CODER/BILLER+ Associate 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+ go-live training in collaboration with market RCM teams.
  • Research and answer BILLER+ claim HOLD questions; deliver instructions to the providers and practice staff.
  • Perform E&M, Procedural, and Surgical coding of professional claims as assigned
  • 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 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
    • Provide HOLDs breakdown and aging report Check-in Log
    • 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

Qualifications

  • 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 be a Certified Professional Coder
  • 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