Risk Adjustment Documentation & Coding Educator

Privia Medical Group; United States; Remote; USD 70,000 - 87,000; Full time

Job summary

An established industry player seeks a Risk Adjustment Documentation & Coding Educator to enhance risk adjustment capabilities through training and education. This role involves developing relationships with clinicians, delivering training on coding guidelines, and ensuring compliance with documentation standards. The ideal candidate will have extensive knowledge of coding practices, strong communication skills, and a passion for improving healthcare outcomes. Join a diverse and inclusive team dedicated to optimizing physician practices and enhancing patient experiences in both in-person and virtual settings.

Qualifications

• 5+ years of experience with coding and documentation.
• Knowledge of federal laws and regulations affecting risk adjustment.
• Extensive knowledge of CMS and AMA guidelines.

Responsibilities

• Conduct training on the HCC Risk Adjustment model with providers.
• Educate on documentation and coding guidelines.
• Analyze coding performance indicators for training needs.

Skills

Coding and Documentation

Communication Skills

Relationship Building

ICD-10-CM Knowledge

CPT Knowledge

HCPCS Knowledge

EHR Workflow Training

Tools

MS Office

EMRs

Encoder

Coding Clinic

G-Suite

Job description

Risk Adjustment Documentation & Coding Educator

• Full-time
• Department: Clinical Operations - Market

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.

The Risk Adjustment Documentation & Coding Educator is responsible for supporting the growth and improvement of Privia Health’s risk adjustment capabilities by conducting training, education, and management of coding and documentation improvement programs. The Educator will enhance educational programs to support value-based care initiatives impacting the Medicare Shared Savings Program, Medicare Advantage, and Commercial value-based care agreements. This individual will work in a matrixed organization to deliver complex ideas, support various stakeholders, and assist with executing new risk adjustment initiatives. The ideal candidate is knowledgeable in coding and documentation guidelines, skilled at developing relationships with clinicians, and an effective communicator. Extensive presentation experience in ICD-10-CM, CPT, and HCPCS is required.

The primary responsibilities include:

1. Using primarily the Hierarchical Condition Category (HCC) Risk Adjustment model, conduct training with individual and large provider groups, predominantly in-person.
2. Educate providers on the purpose of risk adjustment and current documentation and coding guidelines.
3. Execute onboarding training plans for new providers in the market.
4. Analyze coding performance indicators to identify providers needing additional training.
5. Identify training priorities and proactively schedule provider training sessions.
6. Train on effective EHR workflows to support coding and documentation for known and suspected conditions.
7. Serve as a level one support for EHR-related risk adjustment documentation and coding questions.
8. Meet key performance indicators and quarterly objectives.
9. Act as the internal subject matter expert and escalation point for risk adjustment and coding documentation.
10. Ensure compliance with all documentation, coding guidelines, and legal requirements.
11. Perform other related duties as needed.

Qualifications include:

• 5+ years of experience with coding and documentation.
• Knowledge of federal laws and regulations affecting risk adjustment documentation and coding, including NCDs and LCDs.
• Extensive knowledge of CMS and AMA guidelines for diagnostic and procedural codes.
• Proficiency with MS Office, EMRs, Encoder, Coding Clinic, G-Suite, and other relevant software.
• A valid driver’s license and reliable vehicle.
• Ability to maintain confidentiality and comply with HIPAA regulations.

The salary range is $70,000 - $87,000 annually, excluding bonuses and benefits. The role is eligible for an annual bonus targeted at 10%. The final salary depends on experience, education, and location.

All information will be kept confidential per EEO guidelines.

Technical Requirements (remote workers): Minimum internet speeds of 5 MBPS download and 3 MBPS upload are required, verified via online speed tests. Employees working remotely are eligible for expense reimbursement for internet costs.

Privia Health values diversity and encourages applicants of all backgrounds to apply, fostering an inclusive work environment.