Note: The job is a remote job and is open to candidates in USA. Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems. The Coding Compliance Audit & Education Specialist is responsible for auditing medical records for compliance with federal coding regulations and guidelines, conducting provider education, and ensuring adherence to coding principles.

Responsibilities

• 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

Skills

• 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
• Must comply with all HIPAA rules and regulations
• Excellent communication skills and the ability to work independently
• Experience working with MDAudit and Athena is a plus

Benefits

• Medical
• Dental
• Vision
• Life
• Pet insurance
• 401K
• Paid time off
• Other wellness programs

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