Coding Compliance Audit & Education Specialist

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

Under indirect supervision, the Coding Compliance Audit/Education Specialist audits medical records for compliance with federal coding regulations and guidelines. Successful candidates will have extensive knowledge of auditing and education on CPT, ICD-10, and HCPCS codes and guidelines.

• 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.