Risk Adjustment Documentation & Coding Educator (CRC Required)

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

Travel: ~4 Trips a year for Summits/Educations

The Risk Adjustment Documentation & Coding Educator is responsible for supporting the growth and improvement of Privia Health’s risk adjustment capabilities by conducting training, education, and management of coding and documentation improvement programs. The Educator will enhance the educational programs necessary to support value-based care initiatives impacting the Medicare Shared Savings Program and Medicare Advantage and Commercial value-based care agreements. This individual will work in a matrixed organization to deliver complex ideas, support various key stakeholders, and assist with executing new risk adjustment initiatives. The ideal candidate is knowledgeable in coding and documentation guidelines, knows how to develop strong relationships with clinicians, and is an effective, strong communicator. Successful candidates will also have extensive presentation experience in the following areas: ICD-10-CM, CPT and HCPCS.

• Using primarily the Hierarchical Condition Category (HCC) Risk Adjustment model, 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

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.

Additional Information

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

Technical Requirements (for remote workers only, not applicable for onsite/in office work):

In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like https://www.speedtest.net/. This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.

Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. We understand that healthcare is local and we are better when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age, color, national origin, physical or mental (dis)ability, race, religion, gender, sex, gender identity and/or expression, marital status, veteran status, or any other characteristic protected by federal, state or local law.