Coding Compliance Audit & Education Specialist

Privia Health; United States; On-site; USD 70,000 - 80,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

Pet insurance

401K

Paid time off

Wellness programs

Job summary

Privia Health seeks an experienced audit professional to conduct comprehensive medical record audits, verify CPT/ICD-10/HCPCS coding accuracy, and educate providers on proper documentation and coding practices.

The role emphasizes regulatory compliance, preparation of audit reports, and delivering post-audit education to providers while collaborating with physicians and internal teams to improve coding accuracy and patient outcomes.

Qualifications

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

Responsibilities

• Conduct audits comparing medical record documentation to reported CPT/HCPCS and ICD-10-CM codes.
• Research, interpret and communicate federal and state laws and guidelines pertaining to CMS and Medicare.
• Act as an internal expert on coding issues to ensure regulatory compliance.
• Prepare audit reports including summaries of findings.
• Conduct post-audit provider education with individual or large provider groups.
• Schedule trainings with provider offices and groups of providers.
• Provide feedback, ongoing education, and training on documentation and coding principles.
• Communicate audit findings to providers to track education completion and escalation.
• Interact professionally with physicians, leaders, staff, and internal teams.
• Provide coding assessment, consultation, education, and issue resolution as requested.
• Have honest conversations with providers about compliance, documentation, and code assignment.
• Other duties as assigned

Skills

Audit experience

Provider education

Communication skills

Education

Certified Professional Coder (CPC)

Certified Professional Medical Auditor (CPMA)

Tools

MDAudit

Athena

Job description

Company Description

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.

Company Description

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.

Job Description

• 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

Qualifications

• 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) required and Certified Professional Medical Auditor (CPMA) preferred.
• 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 15%. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

Additional Information

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 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.