Risk Adjustment Auditor Jobs

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.

• Evaluate the appropriateness of diagnoses coded from internal Risk Adjustment programs, vendors, and coders through retrospective reviews
• Perform retrospective medical record documentation reviews of ICD-10 codes linked to HCCs
• Evaluate the appropriateness of diagnoses coded from internal Risk Adjustment programs, vendors, and coders through retrospective reviews
• Prepare formalized reports from audit and education results
• Educate providers when audit findings show insufficient documentation or coding errors
• Monitor provider documentation after education; re-educate as needed

Other Job Duties

• Ability to communicate clearly and effectively both orally and in writing required
• Communicate and problem-solve with senior department managers about specific HCC documentation and coding issues, and training needs
• Perform other assigned responsibilities
• Communicate regularly with leadership to ensure compliance
• Provide monthly HCC education for the Audit and Education teams based on audit findings and risk

Colorado, New York, New Jersey, California and Washington Residents Only: The salary range for this role is $80,750 to $85,000 in base pay and exclusive of any bonuses or benefits. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.
Qualifications

• Five-plus years of HCC coding experience
• AAPC CPC and CRC certification required CDEO certification preferred
• High school diploma or GED preferred
• Knowledge of Athena clinicals is a plus
• Five-plus years of provider education experience
• Bachelor's degree and/or relevant work experience preferred

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.