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 and health systems. The Risk Adjustment Documentation & Coding Educator is responsible for conducting training and education programs to support risk adjustment capabilities, focusing on documentation and coding improvement initiatives.
Responsibilities
- Using primarily the Hierarchical Condition Category (HCC) Risk Adjustment model, conduct training with individual and large provider groups, predominantly virtually
- Educate providers on the purpose of risk adjustment, as well as detailed and current risk adjustment documentation and coding training
- Analyze key coding performance indicators and audit error rates to target high-risk clinical areas or providers requiring intensive data validation.Conduct comprehensive prospective and retrospective medical record chart audits to validate the accuracy of ICD-10-CM coding and HCC assignments
- Ensure all audited charts meet CMS documentation requirements (e.g., MEAT criteria: Monitor, Evaluate, Assess, Treat) and ensuring data integrity, regulatory compliance, and optimal risk score accuracy through rigorous medical record auditing
- Utilize a compliant provider query process to clarify conflicting, ambiguous, or incomplete documentation identified during the chart review process
- Generate detailed audit findings, error reports, and accuracy scores to identify trends in under-coding, over-coding, and documentation vulnerabilities
- Analyze claims data and electronic health records to identify suspected gaps in care and recapture opportunities for chronic conditions
- Identify training priorities and proactively schedule provider trainings with provider’s offices, individual providers and groups of providers
- Train on effective EHR workflows to support coding and documentation for both known and suspected conditions
- Expert in how providers document and code in the EHR clinical record
- Meet key performance indicators and quarterly objectives
- Act as the internal subject matter expert and escalation point for risk adjustment, and coding documentation
- Accurately follow documentation and coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies
- Perform other related duties, which may be inclusive, but not listed in the job description
Skills
- 5+ years' experience with coding and documentation
- Certified Professional Coder (CPC) required; Certified Risk Adjustment Coder (CRC) Required
- Federal laws and regulations, including NCDs and LCDs affecting risk adjustment documentation and coding compliance
- Extensive knowledge of documentation and coding guidelines established by the Center for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) for assignment of diagnostic and procedural codes
- MS Office Suite, Electronic Medical Records, Encoder, Coding Clinic, G-Suite, other software programs and internet based applications as needed to fulfill position duties
- A valid unrestricted drivers' license and a reliable vehicle
- Maintain patient, team member and employer confidentiality; comply with all HIPAA regulations
Benefits
- Medical, dental, vision, life, and pet insurance
- 401K
- Paid time off
- Other wellness programs
- Annual bonus targeted at 10%
Company Overview