Full-Time Coding & Billing Claims Specialist

Coding & Billing Claims Specialist (CPC) Responsibilities:

Under supervision, process claims accurately and timely. Respond to correspondence, handle calls, and provide information. Assist with go-live training. Collaborate with providers and Privia staff.

Key Duties:

• HOLD and Denial Management: Investigate denial sources, resolve and appeal holds/denials (contacting payers). Independently adjust claims (resubmission, appeals, etc.).
• Training and Communication: Assist with CODER/BILLER+ trainings. Research and answer Biller+ claim HOLD questions; provide instructions to providers.
• Case Management: Manage Salesforce cases, claims, Biller+ and Coder+ cases. Escalate coding issues to vendor and relay solutions to care centers.
• Compliance and Communication: Monitor and respond to emails timely. Adhere to federal and state regulations. Collaborate with Success Management. Provide HOLDs breakdown and aging report. Identify trends and solicit feedback.
• Additional Responsibilities: Review current HOLDs, set expectations, provide additional training, and complete cleanup projects.

Qualifications:

• High School diploma or equivalent.
• Medical office training certificate or relevant experience.
• 3+ years of claim and denials management experience.
• 3+ years of experience in medical billing office (preferred).
• Understanding of revenue cycle optimization.
• Experience with athenaHealth tools (preferred).
• HIPAA compliance.
• Effective communication with physicians, practice staff, and external parties.

Technical Requirements (Remote):

• Minimum download speed: 5 Mbps
• Minimum upload speed: 3 Mbps

Compensation:

$55,000.00 - $65,000.00 base salary, plus bonus (up to 10%), and benefits.

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