Medical Coding Quality Assurance Specialist (CPC)

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

The Coder+ Quality Assurance Specialist will be accountable for executing the quality assurance program related to CODER+ services provided by Privia Health. The QA Specialist 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 reviewing 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 Quality Assurance Specialist will perform Evaluation and Management coding, procedure, ICD-10 and HCPC quality reviews as well as other projects related to physician coding. The ideal candidate demonstrates a thorough understanding of complex coding and reimbursement as they relate to physician practices and clinic settings.

Job Requirements:

• 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
• Meet with providers and clinic staff as needed
• Educate coders and other staff on appropriate coding guidelines
• Assist in development and ongoing maintenance of processes and procedures for each assigned client
• Collaborate with internal Privia+ and Privia teams
• Collaborate with vendor partners
• Follow coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies
• Assist in the Privia+ day-to-day coding/educational needs as needed
• Other duties as assigned

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
• CPMA preferred 
• Athena EMR experience preferred 
• 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
• Passion for efficiency and a drive to reduce redundancy
• Professional, 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
• Strong team player with ability to manage up members of team to encourage partnership and cooperation with clinic staff

The salary range for this role is $65,000.00 to $75,000.00 in base pay. This role is also eligible for an annual bonus targeted at 10% based on the performance for the role. 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. Privia is a better company 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.