Sr. Coding Analyst

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

The Senior Coding Analyst is responsible for performing coding and data integrity review activities for Community Medical Group (CMG) and its members. The position is responsible for coding, abstracting and clinical documentation integrity review activities for physician and mid-level providers in office-based practices. Works with members to assist in maximizing timely and accurate coding/abstracting of medical records according to the established organizational standards. Reviews the accuracy of diagnosis and procedure coding as documented for accurate reporting of services. The Senior Coding Analyst is responsible for providing in-office audits of medical record documentation, in-service education to physicians and practices members through formal training and review of work performed. Work situations are varied and require data analysis, organization, independent thinking, good judgment, decision making and attention to detail, follow-through and prioritization.  This position requires the development of consultative/collaborative relationships internally and externally.  Serves as functional subject matter expert in regard to both clinical documentation improvement, as well as all coding and reimbursement systems, including CPT, HCPCS and ICD-10-CM/PCS. Position reports to the Director, Population Health.

Primary Responsibilities:

• Implements organization-wide coding and clinical documentation integrity program in an organized and standardized manner
• Performs chart audits in CMG member practices and provides feedback and education related to audit results
• Facilitates appropriate clinical documentation to support diagnosis capture, specificity, and accuracy
• Reviews clinical issues with member physicians, providers and practice staff to identify those diagnoses that impact severity of illness indicators for each patient 
• Oversees processes requiring clinical knowledge and knowledge of coded data for documentation requirements to improve overall patient quality, capture severity, acuity and risk 
• Serves as an expert resource in reviewing all medical records in support of consistent documentation for all payer types to ensure complete and accurate diagnosis capture and coding
• Collaborates in the development of programs, initiatives, and work flows which provide alignment with education for CMG members to support clinical documentation guidelines
• Effectively communicates (in a timely manner) with physicians, mid-level providers and practices 
• Conducts quality assurance reviews pertaining to coding, processes and functions, resulting in the reporting of any corrective action
• Serves on committees and work groups as needed (and as is appropriate) 
• Act as liaison between CMG and the members in an attempt to increase physician awareness of documentation guidelines in relation to reimbursement
• Updates CMG members on any trends seen by the Coding & 
• CDI staff that may be of an education value to the members 
• Analyzes practice performance data in the risk adjustment program and identifies areas of opportunity 
• Supports coding initiatives by providing education at practice visits with medical director of provider outreach
• Reviews new coding guidelines and advises the members if any of the coding guidelines effect physician documentation
• Monitor guidelines and any new information related to coding to be published in the newsletter
• Mentor/Train new employees for clinical coding and documentation specialist position
• Supports and provides training and education of members on clinical coding and documentation 

Qualifications

• 5+ years’ experience coding all types of medical records in a physician practice setting or large group practice. Additional experience in procedural clinical coding a plus.
• CPC (Certified Professional Coder) or equivalent.
• Prior Clinical Documentation Improvement experience, either as a specialist/analyst or as a Clinical Coder and Documentation Specialist, including physician office, multi-specialty group practice and extensive knowledge of coding classification systems such as CPT, HCC, HCPCS and ICD-10-CM, or similar meth