Coding Compliance Audit & Education Specialist

SmartRecruiters, Inc.; Northern (KY); Hybrid; USD 70,000 - 80,000; Full time

Benefits offered by this job

Medical, dental, vision insurance

Life insurance

401K plan

Paid time off

Wellness programs

Job summary

Privia Health seeks a Coding Compliance Audit & Education Specialist to audit medical records for compliance with CPT, ICD-10, and HCPCS guidelines and to educate providers on proper coding practices.

The role involves evaluating documentation, preparing audit reports, and delivering training to providers, while ensuring HIPAA compliance and professional interactions with clinicians.

Qualifications

• Audits medical records for CPT/HCPCS/ICD-10-CM codes per federal and state regulations.
• Extensive knowledge of CPT, ICD-10, and HCPCS coding guidelines required.
• HIPAA compliance and independent work ability are essential.

Responsibilities

• Conduct audits (baseline, routine, focused) comparing documentation to codes.
• Research and communicate CMS/Medicare rules and state laws.
• Serve as internal coding expert to ensure regulatory compliance.
• Prepare audit reports with findings summary.
• Lead post-audit education for providers or groups.
• Schedule and deliver trainings to providers and offices.
• Provide feedback and ongoing training on documentation, service selection, charge capture, and coding principles.
• Communicate audit findings to providers and monitor education completion.

Skills

Audit experience

Provider education

CPT knowledge

ICD-10 knowledge

HCPCS knowledge

CPC

CPMA

HIPAA compliance

Communication skills

Education

CPC certification

CPMA certification

Tools

MDAudit

Athena

Job description

Coding Compliance Audit & Education Specialist

• Full-time
• Department: Audit & Coding

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.

Under indirect supervision, the Coding Compliance Audit/Education Specialist audits medical records for compliance with federal coding regulations and guidelines. Successful candidates will have extensive knowledge of auditing and education on CPT, ICD-10, and HCPCS codes and guidelines.

• 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

• 5+ years of audit and provider education experience is preferred.
• Extensive knowledge of CPT, ICD-10, and HCPCS codes and guidelines.
• Certified Professional Coder (CPC) and Certified Professional Medical Auditor (CPMA) required.
• Experience working with MDAudit and Athena is a plus.
• Must comply with all HIPAA rules and regulations.
• Excellent communication skills and the ability to work independently.

The salary range for this role is $70,000.00 to $80,000.00 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 10%. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

All your information will be kept confidential according to EEO guidelines.

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. We understand that healthcare is local and we are better whenour 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.