Audit & Education Specialist

Privia Health Arlington , VA 22201

Posted 2 months ago

Overview of the role:

Under indirect supervision, the Audit and Education Specialist audits medical charts and records for compliance with federal coding regulations and guidelines. Uses knowledge of UNM/UPA and client systems and procedures to provide a second level review of codes assigned to medical diagnoses and clinical procedures, ensuring that medical billing conforms to legal and procedural requirements. Reviews, develops, and/or modifies client procedures, systems, and protocols to achieve and maintain compatibility with Privia coding and billing compliance standards.

Primary Job Duties:

  • Audits medical record documentation to identify undercoded and upcoded services; prepares reports of findings and meets with providers to provide education and training on accurate coding practices and compliance issues.

  • Provides second-level review of billing performances to ensure compliance with legal and procedural policies and to ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices.

  • Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials, and billable services.

  • Interacts with physicians and other patient care providers regarding billing and documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific documentation.

  • Trains, instructs, and/or provides technical support to medical providers and Medical Coding Analysts as appropriate regarding coding compliance documentation, and regulatory provisions, and third party payer requirements.

  • Interacts with providers and management to review and/or implement codes and to update charge documents.

  • Ensures strict confidentiality of financial records.

  • Performs all focused projects as assigned.

  • Performs miscellaneous job-related duties as assigned.

Minimum Qualifications:

  • High school diploma or equivalent required

  • Associate's Degree or higher preferred

  • Coding experience preferred

  • Certified Professional Coder (CPC) required and Certified Professional Medical Auditor (CPMA) or willingness to obtain certification within 6 months of obtaining position required

  • Proficient ability to use a computer and electronic medical record.

  • Must comply with all HIPAA rules and regulations.

Interpersonal Skills & Attributes:

  • Knowledge of coding, reimbursement, billing and insurance requirements and regulations.

  • Ability to perform work accurately and thoroughly.

  • Ability to communicate effectively verbally and in writing

  • Ability to pay attention to the minute details of a project or task

  • Ability to adapt easily to changing conditions and work responsibilities.

  • Work as part of a team and collaborate with co-workers.

  • Ability to complete assigned tasks under stressful situations.

Physical Demands:

Work is performed in an office environment. Employee must have the ability to lift, move and store supplies and other material weighing up to 50 lbs. Specific vision requirements include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.

Privia Health is committed to providing equal employment opportunity to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, Privia will provide reasonable accommodations for qualified individuals with disabilities. Privia's goal is for our people to reflect the communities that we serve and to increase representation of women, people of color, veterans and individuals with disabilities in our organization.


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Audit & Education Specialist

Privia Health