Note: The job is a remote job and is open to candidates in USA. Privia Health is a technology-driven physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices and improve patient care. The Coding Compliance Audit & Education Specialist audits medical records for coding compliance, interprets applicable regulations, prepares audit reports, and provides coding education and support 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.
Company Overview