Risk Adjustment Documentation & Coding Educator (CRC Required)

Risk Adjustment Documentation & Coding Educator

About the role

The Risk Adjustment Documentation & Coding Educator supports the growth and improvement of Privia Health’s risk adjustment capabilities by conducting training, education, and management of coding and documentation improvement programs. This individual works in a matrixed organization to deliver complex ideas, support various key stakeholders, and assist with executing new risk adjustment initiatives.

Responsibilities

• Conduct training with individual and large provider groups, predominantly virtually
• Educate providers on the purpose of risk adjustment, as well as detailed and current risk adjustment documentation and coding training
• Analyze key coding performance indicators and audit error rates to target high-risk clinical areas or providers requiring intensive data validation
• Conduct comprehensive prospective and retrospective medical record chart audits to validate the accuracy of ICD-10-CM coding and HCC assignments
• Ensure all audited charts meet CMS documentation requirements (e.g., MEAT criteria: Monitor, Evaluate, Assess, Treat) and ensuring data integrity, regulatory compliance, and optimal risk score accuracy through rigorous medical record auditing
• Utilize a compliant provider query process to clarify conflicting, ambiguous, or incomplete documentation identified during the chart review process
• Generate detailed audit findings, error reports, and accuracy scores to identify trends in under-coding, over-coding, and documentation vulnerabilities
• Analyze claims data and electronic health records to identify suspected gaps in care and recapture opportunities for chronic conditions
• Identify training priorities and proactively schedule provider trainings with provider’s offices, individual providers and groups of providers
• Train on effective EHR workflows to support coding and documentation for both known and suspected conditions
• Expert in how providers document and code in the EHR clinical record
• Meet key performance indicators and quarterly objectives
• Act as the internal subject matter expert and escalation point for risk adjustment, and coding documentation
• Accurately follow documentation and coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies
• Perform other related duties, which may be inclusive, but not listed in the job description

Qualifications

• 5+ years’ experience with coding and documentation
• Certified Professional Coder (CPC) required; Certified Risk Adjustment Coder (CRC) Required
• Federal laws and regulations, including NCDs and LCDs affecting risk adjustment documentation and coding compliance
• Extensive knowledge of documentation and coding guidelines established by the Center for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) for assignment of diagnostic and procedural codes
• MS Office Suite, Electronic Medical Records, Encoder, Coding Clinic, G-Suite, other software programs and internet based applications as needed to fulfill position duties
• A valid unrestricted drivers’ license and a reliable vehicle
• Maintain patient, team member and employer confidentiality; comply with all HIPAA regulations

Pay

The salary range for this role is $70,000 to $85,000 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 10%. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.