风险调整文档与编码教育者（需CRC）
Risk Adjustment Documentation & Coding Educator (CRC Required)
Privia Health™ 是一家以技术驱动的全国性医生赋能公司，与医疗集团、医保计划和医疗系统合作，优化医生执业，改善患者体验，并对在面对面和虚拟环境中提供高价值护理的医生进行奖励。Privia 平台由行业顶尖人才和卓越的医生领导团队打造，包含可扩展的运营体系和端到端的基于云的技术，从而减少不必要的医疗成本，实现更好的治疗效果，并提升患者的健康水平和医护人员的福祉。
出差：每年约 4 次峰会/培训
风险调整文档与编码教育者负责通过开展培训、教育和管理编码及文档改进项目，支持 Privia Health 风险调整能力的增长和提升。该职位将增强必要的教育项目，以支持影响 Medicare Shared Savings Program（Medicare 共享节省计划）以及 Medicare Advantage 和商业价值-based 护理协议的价值护理倡议。该职位将在矩阵式组织中工作，以传达复杂理念，支持各类关键利益相关者，并协助执行新的风险调整计划。理想的候选人应熟悉编码和文档指南，懂得如何与临床医生建立牢固关系，并具备出色的沟通能力。成功的候选人还应在以下领域拥有丰富的演示经验：ICD-10-CM、CPT 和 HCPCS。
· 主要使用 Hierarchical Condition Category（HCC）风险调整模型，为个人和大型医疗机构提供培训，主要以虚拟方式
· 教育医生了解风险调整的目的，以及详细的当前风险调整文档和编码培训
· 分析关键编码绩效指标和审计错误率，以确定高风险临床领域或需要大量数据验证的医生。进行全面的前瞻性及回顾性医疗记录图表审计，以验证 ICD-10-CM 编码和 HCC 分配的准确性
· 确保所有审计的图表符合 CMS 文档要求（例如 MEAT 标准：Monitor, Evaluate, Assess, Treat），并通过严格的医疗记录审计确保数据完整性、监管合规性和最佳风险评分准确性
· 使用合规的医生查询流程来澄清冲突
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.
Travel: ~4 Trips a year for Summits/Educations
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 virtually
· Educate providers on the purpose of risk adjustment, as well as detailed and current risk adjustment documentation and coding training
· Analyze key coding performance indicators and audit error rates to target high-risk clinical areas or providers requiring intensive data validation.Conduct comprehensive prospective and retrospective medical record chart audits to validate the accuracy of ICD-10-CM coding and HCC assignments.
· Ensure all audited charts meet CMS documentation requirements (e.g., MEAT criteria: Monitor, Evaluate, Assess, Treat) and ensuring data integrity, regulatory compliance, and optimal risk score accuracy through rigorous medical record auditing
· Utilize a compliant provider query process to clarify conflicting, ambiguous, or incomplete documentation identified during the chart review process.
· Generate detailed audit findings, error reports, and accuracy scores to identify trends in under-coding, over-coding, and documentation vulnerabilities.
· Analyze claims data and electronic health records to identify suspected gaps in care and recapture opportunities for chronic conditions.
· 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
· 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
- 5+ years’ experience with coding and documentation
- Certified Professional Coder (CPC) required; Certified Risk Adjustment Coder (CRC) Required
- 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 $85,000 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.