Coding and Vendor Performance Manager (CPC)

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.

The Vendor Performance Manager - Medical Coding and Billing leads the vendor management team in implementing and managing a formalized process for selecting, monitoring, and auditing third-party medical coding and billing vendors. This includes overseeing all aspects of the vendor management lifecycle, from initial selection and onboarding to ongoing performance monitoring, risk management, and contract compliance. This role ensures vendor compliance with coding accuracy standards, billing regulations, HIPAA, contractual obligations, and internal policies, while driving operational efficiencies and minimizing risk. The Manager will also oversee vendor relationships, performance, and onboarding processes, specifically focusing on the unique requirements of medical coding and billing services.

Responsibilities:

• Vendor Management Oversight: Oversee all aspects related to the Vendor Management department and third-party medical coding and billing vendor relationships. This includes leading and mentoring the vendor management staff in the implementation and management of a formalized process for selecting, monitoring, and auditing these vendors.
• Coding and Billing Quality Monitoring & Reporting: Develop and maintain a robust system for monitoring and reporting on vendor coding accuracy rates, billing compliance, claim submission success rates, and adherence to client-specific requirements. Prepare regular reports for senior management on vendor performance, compliance status, service quality, and risk profiles. Analyze performance trends and recommend improvements to coding accuracy, billing efficiency, and revenue cycle management. Ensure proper tracking, measurement, and reporting to evaluate vendor performance using the vendor scorecard performance and monthly trending analysis.
• Compliance & Risk Management (Coding and Billing Focus): Manage, monitor, and track compliance of all third-party vendors to regulatory requirements (e.g., HIPAA, ICD-10 guidelines, billing regulations) and internal policies by ensuring activities adhere to established service levels. Conduct periodic risk reviews of critical/high risk vendors. Prepare risk assessments of new and existing vendors and develop strategies and procedures to minimize risk. Assess and assign risk tolerance based on regulatory requirements. Manage action plans as needed to ensure compliance.
• Contract Management & SLA Compliance: Monitor and report on SLA compliance and other contractual covenants and obligations to ensure compliance.
• Process Improvement (Coding and Billing Focus): Proactively review and analyze current business processes related to medical coding and billing vendor management and identify opportunities to increase compliance and operational efficiencies.
• Vendor Onboarding & Due Diligence (Coding and Billing Focus): Oversee vendor onboarding due diligence requirements according to company policy.
• Vendor Complaint Management (Coding and Billing Focus): Oversee and monitor vendor complaints according to Company Policy. Serve as the first point of contact if vendors are non-responsive to team requests. Escalate items immediately if vendor remains non-compliant.
• Vendor Scorecard Management (Coding and Billing Focus): Oversee monthly vendor scorecard review process, including but not limited to timely completion, performance analysis, action plan documentation and follow up. Oversee vendor scorecard meetings to ensure active follow up on automation and business unit requirements.
• Communication & Escalation (Coding and Billing Focus): Serve as the primary point of contact for vendor escalations related to medical coding and billing issues.
• Team Leadership & Development: Manage, mentor, and develop the vendor management team.
• Document Management: Monitor, evaluate, and approve department forms, job aids and/or documents to ensure compliance and timeliness as it relates to vendor management.

• High School diploma, Medical Office training certificate or relevant experience preferred
• 5+ years of experience in vendor management, with a strong focus on healthcare services necessary for success in this role
• Certified Professional Coder (CPC) or equivalent certification required
• In-depth knowledge of medical coding and billing procedures (ICD-10-CM, CPT, HCPCS)
• Strong understanding of HIPAA regulations, data security, and compliance requirements
• Excellent analytical and problem-solving skills
• Strong communication, negotiation, and interpersonal skills
• Project management and organizational skills
• Experience with contract negotiation and management

The salary range for this role is $66,000.00 - $82,000.00 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 15% and restricted stock units. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

Technical Requirements (for remote workers):

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.

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.