Note: The job is a remote job and is open to candidates in USA. Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices and improve healthcare outcomes. The Coding Compliance Audit & Education Specialist audits medical records for compliance with federal coding regulations, prepares audit reports, researches applicable laws and guidelines, and provides coding education and training to providers and internal stakeholders.
Responsibilities
- Conduct audits (i.e. baseline, routine periodic, and focused) comparing medical record documentation to reported CPT/HCPCS and ICD-10-CM codes with consideration of applicable federal and state laws, regulations, and guidelines
- Research, interpret and communicate federal and state laws and guidelines pertaining to CMS and Medicare
- Acts as an internal expert on coding issues to ensure compliance with state and federal regulations
- Preparation of audit reports including summary of findings
- Conduct post-audit provider education with individual or large provider groups
- Schedule trainings with provider’s offices, individual providers and groups of providers
- Provides feedback, initial and ongoing education and training, and technical support with regard to proper documentation guidelines, service selection, charge capture, supervision, timely submission, healthcare data accuracy, and coding principles
- Communicates audit findings to providers to track education completion and escalation
- Interacts professionally and effectively with physicians, leaders, staff, and internal teams
- Provides coding assessment, consultation, education, and issue resolution to key stakeholders as requested
- Able to have honest, difficult conversations with providers about compliance, documentation, and code assignment
- Other duties as assigned
Skills
- Extensive knowledge of CPT, ICD-10, and HCPCS codes and guidelines
- Certified Professional Coder (CPC) and Certified Professional Medical Auditor (CPMA) required
- Must comply with all HIPAA rules and regulations
- Excellent communication skills and the ability to work independently
- 5+ years of audit and provider education experience is preferred
- Experience working with MDAudit and Athena is a plus
Benefits
- Medical, dental, vision, life, and pet insurance
- 401K
- Paid time off
- Other wellness programs
- Annual bonus targeted at 10%
- Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.
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