Risk Adjustment Auditor

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

• Perform retrospective medical record documentation reviews of ICD-10 codes linked to HCCs
• Evaluate the appropriateness of diagnoses coded from internal Risk Adjustment programs, vendors, and coders through retrospective reviews
• Educate providers when audit findings show insufficient documentation or coding errors
• Monitor provider documentation after education; re-educate as needed
• Prepare formalized reports from audit and education results 
• Evaluate the appropriateness of diagnoses coded from internal Risk Adjustment programs, vendors, and coders through retrospective reviews

Other Job Duties:

• Provide monthly HCC education for the Audit and Education teams based on audit findings and risk
• Communicate and problem-solve with senior department managers about specific HCC documentation and coding issues, and training needs
• Communicate regularly with leadership to ensure compliance 
• Ability to communicate clearly and effectively both orally and in writing required
• Perform other assigned responsibilities

Colorado, New York, New Jersey, California and Washington Residents Only: The salary range for this role is $80,750 to $85,000 in base pay and exclusive of any bonuses or benefits. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

Qualifications

• High school diploma or GED preferred 
• Bachelor's degree and/or relevant work experience preferred
• AAPC CPC and CRC certification required  CDEO certification preferred
• Five-plus years of HCC coding experience
• Five-plus years of provider education experience
• Knowledge of Athena clinicals is a plus

Additional Information

All your information will be kept confidential according to EEO guidelines.

Technical Requirements (for remote workers only, not applicable for onsite/in office work):

In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like https://www.speedtest.net/. This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.

Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. Privia is a better company when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age, color, national origin, physical or mental (dis)ability, race, religion, gender, sex, gender identity and/or expression, marital status, veteran status, or any other characteristic protected by federal, state or local law.