Risk Adjustment Coding Specialist CRC or CPC

Privia Health; Houston (TX); Hybrid; USD 60,000 - 70,000; Full time

Job summary

Privia Health is seeking a Risk Adjustment Coding Specialist for a hybrid role located in Houston. The position involves auditing charts, ensuring compliance with coding guidelines, and handling complex coding inquiries. Ideal candidates will possess CPC and CRC certifications, along with solid experience in both primary care and multispecialty environments.

Qualifications

• Minimum 2 years experience using ICD-9-CM/ICD-10-CM coding.
• Strong understanding of HIPAA regulations.
• Knowledge of current coding requirements and billing practices.

Responsibilities

• Perform chart audits to ensure accurate coding and documentation.
• Evaluate record consistency and documentation adequacy.
• Provide complex coding support via email.

Skills

Analytical skills

Communication skills

Research skills

Interpersonal skills

Collaboration

Resourcefulness

Education

AAPC Certified Professional Coder (CPC)

Certified Risk Adjustment Coder (CRC)

Associate's degree

High School Diploma

Tools

AthenaHealth EHR

Job description

Job Description

This full-time position is a hybrid role that requires working in the office on Tuesdays and Thursdays at 1200 Binz St Suite 1490 Houston TX 77004. Mon, Wed, and Fri are typically work from home but may be in office on occasion.

We are currently recruiting for a Risk Adjustment Coding Specialist to join our Gulf Coast Population Health team. The successful candidate will have experience in both primary care and multispecialty and be responsible for ensuring provider documentation is complete and supports provider code selection.

Primary Job Duties:

• Performs chart audits to track ICD-10 coding and documentation to identify improvement opportunities and deficiencies related to Risk adjustment.
• Evaluate the record for consistency and adequacy in documentation. Ensure that the final diagnosis accurately reflects the care and treatment rendered and that there is appropriate supporting documentation.
• Identifies coding trends to be escalated to the coding and documentation educator and population health leadership
• Performs chart audits and data submission on payor portals as part of payer program incentive programs.
• Performs a comprehensive review of the record to assure the presence of all parts such as patient and record identification, signatures and dates where required, and all other necessary data in the presence of all reports that appear to be indicated by the nature of the treatment rendered.
• Answers internal and external complex coding email questions daily
• Maintains compliance standards in accordance with the Compliance policies
• Accurately follows coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies
• Performs other related duties, which may be inclusive, but not listed in the job description
• Knowledge of: Federal laws and regulations affecting coding requirements
• Principles, practices, and methods of current coding certificate required
• Knowledge of billing practices required
• Knowledge of medical records, and EHR required
• Extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codes.
• Must comply with all HIPAA rules and regulations
• Other duties as assigned

Qualifications:
Qualifications

• High School Diploma: Associate’s degree preferred
• AAPC Certified Professional Coder (CPC) certification is preferred, CPC and Certified Risk Adjustment Coder (CRC) is required
• Two years experience using ICD-9-CM/ICD-10-CM coding
• AthenaHealth EHR experience a plus
• Excellent interpersonal skills, communication skills, analytical skills, and research skills
• Strong ability to collaborate, be resourceful, and team skills

The salary range for this role is $60,000 - $70,000 in base pay and exclusive of any bonuses or benefits 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.

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 likehttps://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. Privia is a better company 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.