Coding Compliance Audit & Education Specialist

Privia Health•Remote, USA

3d•$70,000 - $80,000•Remote

About The Position

Under indirect supervision, the Coding Compliance Audit/Education Specialist audits medical records for compliance with federal coding regulations and guidelines. Successful candidates will have extensive knowledge of auditing and education on CPT, ICD-10, and HCPCS codes and guidelines. Conduct audits (i.e. 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. Other duties as assigned

Requirements

Extensive knowledge of CPT, ICD-10, and HCPCS codes and guidelines.
Certified Professional Coder (CPC) required
Must comply with all HIPAA rules and regulations.
Excellent communication skills and the ability to work independently.

Nice To Haves

5+ years of audit and provider education experience is preferred.
Certified Professional Medical Auditor (CPMA) preferred.
Experience working with MDAudit and Athena is a plus.

Responsibilities

Conduct audits (i.e. 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.
Other duties as assigned