Risk Adjustment Documentation & Coding Educator

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.

Travel: 5%, ~4 trips a year for summits/team meetings

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 in-person
• Must demonstrate the ability to execute end-to-end risk adjustment audits and articulately communicate audit outcomes to diverse audiences
• Educate providers on the purpose of risk adjustment, as well as detailed and current risk adjustment documentation and coding training
• Execute on risk adjustment onboarding training plans with new providers in the market
• Analyze key coding performance indicators to determine those providers in need of initial or additional training.
• 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; serve as level one support for basic EHR customer support questions specific to risk adjustment workflows
• 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

The salary range for this role is $70,000.00 to $83,000.00 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

• Certified Professional Coder (CPC) required; CPC and Certified Risk Adjustment Coder (CRC) required
• ACDIS CCDS Certification preferred
• 5+ years experience with coding and documentation
• Athena EMR experience highly preferred
• 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…