Coding Analyst - New Haven, United States - Privia Health

Description

Job Description

Privia HealthTM 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 Required: 30% MUST BE LOCATED IN CT

The Coding Analyst is responsible for performing coding and data integrity review activities for Privia Health and its members. The position is responsible for coding, abstracting and clinical documentation integrity review activities for physician and mid-level providers in office-based practices. This position requires the development of consultative/collaborative relationships internally and externally. Serves as functional subject matter expert regarding clinical documentation improvement, as well as coding and reimbursement systems, including CPT, HCPCS and ICD-10-CM/PCS. Position reports to the Director Quality.

Primary Job Duties:

• Performs chart audits in Privia member practices and provides feedback and education related to audit results
• Conducts quality assurance reviews pertaining to coding, processes and functions, resulting in the reporting of any corrective action
• Analyzes practice performance data in the risk adjustment program and identifies areas of opportunity
• Educate providers on the purpose of risk adjustment, as well as detailed and current risk adjustment documentation and coding training
• Supports coding initiatives by providing education at practice visits with medical director of provider outreach
• Train on effective EHR workflows to support coding and documentation for both known and suspected conditions
• Reviews new coding guidelines and advises the members if any of the coding guidelines effect physician documentation
• Accurately follow documentation and coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies

• Certified Professional Coder (CPC) required; CPC and Certified Risk Adjustment Coder (CRC) preferred
• Five years' experience with coding and documentation
• 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 $80,000 in base pay and exclusive of any bonuses or benefits. 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.

All of 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 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.