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
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 $170,000 to $180,000 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.
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.
