VP, Compliance & Coding Integrity

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

This role requires 15% travel

Under the direction of the Chief Audit & Compliance Officer, the VP, Compliance & Coding Integrity is responsible for the oversight and supervision of the Coding, Audit & Education team. The Coding, Audit & Education team provides ongoing audit and teaching of documentation and coding processes to physicians and staff within Privia Care Centers. 

The VP develops and oversees Privia’s Coding Compliance Program, leading the company’s internal monitoring and auditing of coding and documentation through the performance of periodic audits, implementing written policies and procedures, conducting appropriate training and education, and ensuring appropriate corrective action is taken.  The VP ensures compliance with CMS rules as defined by the MAC for each region and serves as point of contact for any focused review from Medicare or other payers, and coordinates responses for the organization to the payer. They are a subject matter expert and will provide guidance to the organization for all matters concerning coding, billing, claim accuracy and compliance related to claim submission or adjudication.  They will report the Coding Compliance Program activities and results to the Compliance Committees of Privia Health Group, Inc.,  Privia Medical Groups, and Privia’s Accountable Care Organizations.

Qualifications

• Keep abreast of all changes in coding regulations, CMS or payer rules related to coding and communicate to the organization information necessary to ensure accurate claim submission.
• Collect, analyze, and present coding trends and metrics to senior leadership and to the relative Board Compliance Committees.
• Ensure that coding and documentation audits are done accurately and timely, findings are communicated and reviewed with providers, and necessary payer refunds are paid timely.
• Manage the Coding Audit & Education team including providing oversight, training and quality review for audit managers.
• Develop and oversee a comprehensive coding and documentation training program to ensure continuous skill development and compliance with industry standards.
• Assist the Chief Audit and Compliance Officer in any investigations related to coding and documentation.
• Work directly with providers as needed on coding matters and oversee a process to ensure provider questions are addressed timely and accurately.
• Stay updated with evolving coding guidelines, regulations, and technologies, and integrate these updates into training materials.
• Develop and implement strategies to foster a positive work environment that encourages collaboration, innovation, and personal growth.
• Conduct regular feedback sessions, performance evaluations and career development discussions with Compliance and Coding Integrity team members.

• Provide insights and recommendations to drive strategic decision making and operational excellence.
• Develop reports that showcase productivity, quality, and Coding Audit and Education Team engagement trends.

• Perform research and provide guidance to the organization on all matters related to CMS and payer rules and regulations.
• Develop and maintain a system for tracking coding audits, provider compliance with audits and any necessary training. Identify gaps in training or compliance and report as necessary to the appropriate internal committees.
• Develop training materials, tip sheets, coding tools, guides and other documentation to support the providers and internal teams to ensure coding excellence and compliance.
• Conduct training sessions at physician group meetings, individual provider meetings, in either a webinar or in person format.
• Identify opportunities for development and assess significance of any deficiencies in knowledge or coding compliance issues and bring to the attention of the Chief Compliance Officer,  Compliance Committee or other leadership.
• Provide subject matter expertise to other teams including but not limited to Population Health, New Product Development, Growth, Marketing, Implementation and Performance Management.
• Provide thought leadership on coding and documentation to committees or other leadershi