Coding Compliance Auditor & 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

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.