Coding Compliance Auditor

Privia Health, LLC; United States; On-site; USD 85,000 - 110,000; Full time

Job summary

Privia Health, LLC is seeking a Coding Compliance Audit & Education Specialist to audit medical records for compliance with CPT, ICD-10, and HCPCS guidelines in a full-time role. Responsibilities include auditing records, educating providers, and ensuring adherence to federal coding regulations.

The role requires CPC and CPMA certification, extensive CPT/ICD-10/HCPCS knowledge, and experience with MDAudit and Athena to support data-driven improvements across diverse clinical settings.

Qualifications

• 5+ years of audit and provider education experience.
• Extensive knowledge of CPT, ICD-10, and HCPCS codes and guidelines.
• Certified Professional Coder (CPC) and CPMA required.
• HIPAA compliance with all rules and regulations.
• Experience with MDAudit and Athena is a plus.

Responsibilities

• Conduct audits comparing medical record documentation to reported codes while adhering to federal and state regulations.
• Prepare audit reports and provide post-audit education to individual providers and groups.
• Act as an internal expert on coding issues, offering consultation and technical support to stakeholders.

Skills

Audit experience

Provider education

CPT/ICD-10/HCPCS knowledge

HIPAA compliance

CPC

CPMA

MDAudit

Athena

Tools

MDAudit

Athena

Job description

Auditing medical records for compliance with federal coding regulations, the full-time Coding Compliance Audit & Education Specialist will conduct various audits, provide education to providers, and ensure adherence to CPT, ICD-10, and HCPCS guidelines.

Key responsibilities

• Conduct audits comparing medical record documentation to reported codes while adhering to federal and state regulations
• Prepare audit reports and provide post-audit education to individual providers and groups
• Act as an internal expert on coding issues, offering consultation and technical support to stakeholders

Required qualifications

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