编码合规审计与教育专员
Coding Compliance Audit & Education Specialist
在间接监督下，编码合规审计/教育专家对医疗记录进行合规性审计，以符合联邦编码法规和指南。成功的候选人应具备丰富的CPT、ICD-10和HCPCS代码及指南的审计和教育经验。
- 进行审计（即基线审计、常规周期性审计和重点审计），将医疗记录文档与报告的CPT/HCPCS和ICD-10-CM代码进行比较，并考虑适用的联邦和州法律、法规和指南。
- 研究、解释并传达与CMS和医疗保险相关的联邦和州法律及指南。
- 作为编码问题的内部专家，确保符合州和联邦法规。
- 准备审计报告，包括发现总结
- 对个别或大型医疗机构进行审计后的教育
- 与医疗机构办公室、个别医生和医生群体安排培训
- 就正确的文档指南、服务选择、费用捕获、监督、及时提交、医疗数据准确性及编码原则等方面提供反馈、初始和持续教育和培训以及技术支持。
- 向医生通报审计结果，跟踪教育完成情况和升级处理。
- 与医生、领导、员工和内部团队进行专业有效的互动。
- 按要求为关键利益相关者提供编码评估、咨询、教育和问题解决。
- 能够与医生就合规性、文档和编码分配进行诚实而困难的对话。
- 其他指定职责
- 优先考虑5年以上审计和医生教育经验。
- 精通CPT、ICD-10和HCPCS代码及指南。
- 需要获得认证专业编码员（CPC）和认证专业医疗审计员（CPMA）资格。
- 有使用MDAudit和Athena的经验者优先。
- 必须遵守所有HIPAA规则和法规。
- 优秀的沟通能力，能够独立工作。
该职位的薪资范围为70,000.00至80,000.00美元，不含任何奖金或福利（包括医疗、牙科、视力、人寿和宠物保险、401K、带薪休假和其他健康计划）。该职位还享有年度奖金，目标为10%。提供的基本工资将根据相关因素确定，如经验、教育和地理位置。
查看英文原文
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.
Under indirect supervision, the Coding Compliance Audit/Education Specialist audits medical records for compliance with federal coding regulations and guidelines. Successful candidates will have extensive knowledge of auditing and education on CPT, ICD-10, and HCPCS codes and guidelines.
· 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.
· Preparation of audit reports including summary of findings
· Conduct post-audit provider education with individual or large provider groups
· Schedule trainings with provider’s offices, individual providers and groups of providers
· Provides feedback, initial and ongoing education and training, and technical support with regard to proper documentation guidelines, service selection, charge capture, supervision, timely submission, healthcare data accuracy, and coding principles.
· Communicates audit findings to providers to track education completion and escalation.
· Interacts professionally and effectively with physicians, leaders, staff, and internal teams.
· Provides coding assessment, consultation, education, and issue resolution to key stakeholders as requested.
· Able to have honest, difficult conversations with providers about compliance, documentation, and code assignment.
· Other duties as assigned
- 5+ years of audit and provider education experience is preferred.
- Extensive knowledge of CPT, ICD-10, and HCPCS codes and guidelines.
- Certified Professional Coder (CPC) and Certified Professional Medical Auditor (CPMA) required.
- 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.
- 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.
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. 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.