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.
Coding Compliance Audit & Education Specialist
Location
United States
Posted
6 hours ago
Salary
Not specified
Job Description
Role 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) and Certified Professional Medical Auditor (CPMA) required.
- Experience working with MDAudit and Athena is a plus.
- Must comply with all HIPAA rules and regulations.
- Excellent communication skills and the ability to work independently.
Requirements
- The salary range for this role is $70,000.00 to $80,000.00 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs).
- This role is also eligible for an annual bonus targeted at 15%.
- The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.
Benefits
- All your information will be kept confidential according to EEO guidelines.
- Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.
Job Requirements
- 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) and Certified Professional Medical Auditor (CPMA) required.
- Experience working with MDAudit and Athena is a plus.
- Must comply with all HIPAA rules and regulations.
- Excellent communication skills and the ability to work independently.
- The salary range for this role is $70,000.00 to $80,000.00 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs).
- This role is also eligible for an annual bonus targeted at 15%.
- The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.
Benefits
- All your information will be kept confidential according to EEO guidelines.
- Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.
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