Coding Quality Auditor (CPC & CPMA)

Company Description

Privia Health™ is a national physician platform transforming the healthcare delivery experience. We provide tailored solutions for physicians and providers, creating value and securing their future. Through high-performance physician groups, accountable care organizations, and population health management programs, Privia works in partnership with health plans, health systems, and employers to better align reimbursements to quality and outcomes.

Job Description

The Coding Audit Specialist will be accountable for executing the quality assurance program related to CODER+ services provided by Privia Health.  The Coding Auditor will serve as an integral member of the CODER+ program team, responsible for partnering with vendor partners and internal coders to ensure high quality coding is being performed and that proper feedback is being given.  This position will spend the majority of the time auditing coders, educating coders, and working on various projects that involve coding and education.  The ideal candidate will draw on existing expertise in primary care and specialty medical coding, billing and compliance with government and commercial payers and act as a coding resource within the team.  The Coding Audit Specialist will perform Evaluation and Management coding, procedure, ICD-10 and HCPC quality reviews as well as other projects related to physician coding compliance.  The ideal candidate is a self-starter, comfortable with managing multiple priorities, and a creative problem solver.  The ideal candidate demonstrates a thorough understanding of complex coding and reimbursement as they relate to physician practices and clinic settings.

Primary Job Duties:

• Apply appropriate coding classification standards and guidelines to medical record documentation for accurate coding
• Perform quality assessments of records, including verification of medical record documentation (electronic and handwritten)
• Perform quality assessments of coders completed work to validate standards are met
• Research and answer coding and coding workflow related questions for providers and clinic staff.
• Educate coders and other staff on appropriate coding guidelines
• Assist in development and ongoing maintenance of processes and procedures for each assigned client
• Coordinate with internal Privia teams including CODER+, Compliance, and Risk Adjustment to answer questions.
• Collaborate with vendor partners and internal team
• Manage all escalations through resolution.
• Follow coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies.

Colorado, New York, New Jersey, California and Washington Residents Only: The salary range for this role is $65,000.00-$84,000.00 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

• 5+ years of provider medical coding experience across medical and surgical specialties
• 3+  years experience in coding audit or quality review work
• AAPC Certified Professional Coder (CPC) certification required
• AAPC Certified Professional Medical Auditor (CPMA) certification required
• Experience working in a physician practice setting strongly preferred 
• Ability to work effectively with physicians, advanced practice providers (APP), practice staff, health plan/other external parties and Privia multidisciplinary team
• Extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codes. 
• Must comply with HIPAA rules and regulations

Interpersonal Skills and Attributes:

• Passion for efficiency and a drive to reduce redundancy and waste
• Ability to work in a fast-paced environment with all levels of management
• Able to work through periods of ambiguity
• Strategic and tactical; able to help scale operations for growth
• Clear and concise oral and written communication
• Knack for prioritizing efficiently and multi-tasking
• Self-directed with the ability to take initiative
• Competent in maintaining confidential information
• Enthusiastic with the ability to thrive in an atmosphere of constant change
• Strong team player with ability to manage up members of team to encourage partnership and cooperation with clinic staff.

Additional Information

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

Technical Requirements (for remote workers):

In order to successfully work remote