Coding Compliance Audit & Education Specialist

About the role

The Coding Compliance Audit/Education Specialist position at Privia Health™ is responsible for auditing medical records for compliance with federal coding regulations and guidelines. This role requires extensive knowledge of auditing and education on CPT, ICD-10, and HCPCS codes and guidelines.

Responsibilities

• Conduct audits (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.

Qualifications

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

Pay

The salary range for this role is $70,000.00 to $80,000.00 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 15%.

Schedule

This role is available for remote work. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.