Coding Compliance Audit Specialist

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 Under indirect supervision, the Coding Compliance Audit Specialist conducts baseline, routine, and focused audits by comparing medical record documentation with reported CPT, HCPCS, and ICD-10-CM codes. Successful candidates will have extensive coding audit experience, strong knowledge of CMS and Medicare guidelines, and the ability to interpret and communicate federal and state regulations while serving as an internal expert on coding compliance. CPC and CPMA certifications are required. 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. Other duties as assigned Qualifications 5+ years of audit experience is preferred. Extensive knowledge of CPT, ICD-10, and HCPCS codes and guidelines. Certified Professional Coder (CPC) required and Certified Professional Medical Auditor (CPMA) 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. Additional Information All your information will be kept confidential according to EEO guidelines. 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 10% .The base pay offered will be determined based on relevant factors such as experience, education, and geographic location 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 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. Department: Audit & Coding