Remote Scouter

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 Manager, Privia+, the CODER/BILLER+ 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. This person will assist in Coder/Biller+ go-live training as well as communicate closely with providers and practice staff. The ideal candidate posseses 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:
• Drives HOLD and Denial Management including, but not limited to, the below
actions:
-Investigates denial sources; resolves and appeals HOLDs / Denials, which may
include contacting payer representatives.
-Makes decisions on how to adjust claims, including resubmission, appeals, and other claim resolution techniques

Researches and answers BILLER+ claim HOLD questions; deliver instructions to the
providers and practice staff
• Collaborates, and delivers, high quality CODER/BILLER+ go-live training
• Performs E&M, Procedural, and Surgical coding of professional claims as assigned
• Assists in triage, and management, of support questions utilizing the CRM tool, and
established processes, which can include:
-Routes claims to the appropriate owner
-Manages Biller+ cases
-Manages Coder+ cases
-Serves as the point of contact for care centers by working with the vendor
to resolve coding/billing questions and/or issues, ensuing timely response
back to the care center utilizing the CRM tool
• Monitors and responds to email in a professional and timely manner
• Follows guidelines and legal requirements to ensure compliance with federal and state
regulatory bodies

• Collaborates with Success Management, and Privia Operations, to support check-in
meetings, as assigned, supporting the overall program success and client satisfaction
• Provides HOLD breakdown and aging report Check-in Log
• Identifies trends and solicits feedback from the Care Center to improve program
success
• Reviews current HOLDs in the practice worklist and sets expectations
• Provides additional training sessions with parties as requested
• Delivers timely/quality service on assigned projects
• Prioritize and manages time efficiently to meet the needs of the program
  Engages in team meetings routinely

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 exhibit professional and effective presentation and communication skills
• 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 teams

The salary range for this role is $55,000.00-$62,000.00 in base pay and exclusive of any bonuses or benefits. 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.

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.