AVP - Billing & Coding (CPC)

Company 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

The AVP Privia+ Operations & Quality is responsible for overseeing the strategic and operational leadership of the organization’s medical coding and billing functions. This role will ensure compliance with federal regulations optimize revenue cycle performance and maintain efficient workflows for coding and billing operations across all markets where Privia providers have opted into services. The AVP will work in close collaboration with clinical and administrative leadership as well as teams in RCM customer success and technology to drive operational improvements enhance coding accuracy and uphold the highest standards of quality in all processes.

Job Requirements

• Oversee the development and execution of strategic initiatives related to BILLER+ and CODER+ including (Pro-Fee) and physician practice workflows in a multi-specialty physician practice environment

• Responsible for overall programmatic success of BILLER+ and CODER+ including vendor partnerships operational performance successful implementations client satisfaction and quality

• Lead a team of billing and coding professionals providing coaching support and mentorship

• Responsible for ensuring the global workforce of employed staff and vendor contracted billing and coding teams are delivering on production targets turnaround times quality and other SLAs

• Ensure coding and billing practices comply with relevant laws including HIPAA ICD-10 CPT and CMS guidelines

• Develop review and approve all Standard Operating Procedures (SOPs) regarding coding and billing operations escalations team alignment and/ or vendor/client educational materials

• Implement and oversee quality control practices and provider education teams to ensure accuracy and mitigate compliance risks

• Collaborate with Implementation as needed to ensure successful customer go-lives for large or complex customer implementations and ensure proper system setup

• Partner with customer success to support complex customers as it relates to all coding and billing operations

• Provide updates and reporting on key performance metrics to leadership

• Regularly communicate program updates new features and other important information to customers and internal stakeholders

• Solicit feedback from customers on opportunities to improve or enhance programs

• Identify and/or collaborate with RCM leadership on opportunities to improve the programs through workflow technology and/or partnerships

• Identify and collaborate with Compliance leadership to address needs of the program as needed

• Research and resolve identified issues/questions from clients/internal stakeholders

• Work closely with Priva+ teams to ensure salesforce cases are being addressed timely by assigned staff

• Provides data to leadership on the turnaround time and quality assurance of salesforce service replies

• Lead initiatives to enhance the efficiency of coding and billing processes through automation staff training and system optimization

• Stay current with changes in healthcare regulations reimbursement models and payer requirements to adjust processes accordingly

• Minimal travel to client sites for onboardings and/or performance management (as needed)

• Other duties as assigned

Qualifications

• Bachelor’s degree in Healthcare Administration Health Information Management or related field Master’s degree preferred

• Minimum of 8+ years of demonstrated knowledge and expertise of physician revenue cycle physician professional coding and physician professional billing and practice workflows

• Minimum of 3+ years experience managing a global revenue cycle team of direct reports (billers and coders) and vendor partners

• Minimum of 5+ years experience in a leadership role

• Certified Professional Coder (CPC) required with a minimum of 10+ years of experience in Evaluation & Management Coding and various specialties

• Certified Professional Biller (CPB) preferred

• In-depth knowledge of ICD-10 CPT HCPCS coding and payer regulations

• Coding Auditing experience preferred

• Compliance experience a plus

• Ability to work effectively with clinicians and staff to implement change

• Strong communication analytical reporting and project management skills

• Strong denial management experience

• Strong knowledge of E/M (Evaluation & Management) coding and Value Based Care Coding

• Experience with athenahealth PMS/EHR a plus

• Experience with multi-specialty service lines and coding/billing preferred

• Must comply with HIPAA rules and regulations

The salary range for this role is $170000 to $175000 in base pay. This role is also eligible for an annual bonus targeted at 25% and restricted stock units based on performance in the role. 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 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.