The Coding Compliance Audit Associate is responsible for supporting the audit process by maintaining accurate records and tracking data for providers and care centers. This role involves managing audit schedules, monitoring the completion of necessary training, and coordinating the assignment of audits to auditors. The role requires strong organizational skills, attention to detail, and effective communication to support smooth audit operations.
The salary range for this role is $46.000 to $58,000 in base pay. This role is also eligible for an annual bonus targeted at 10% based on performance in the role. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.
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The Credentialing Auditor Manager’s responsibility will be to conduct daily audits of 100% of credentialing files to ensure compliance with NCQA standards as well as to ensure that all demographic information is present and correct in the group record.
Primary Job Duties:
Conducts daily audits of the credentialing files.
Assists with the development of corrective action steps needed when any trends are identified that need to be addressed.
Tracks and trends errors in the system and provides monthly reports to leadership with results.
Attends regularly scheduled meetings with leaders to share results and concerns based on audits.
Assists with reviews of monthly rosters for any data errors/issues and shares those results with the leadership team for action.
Makes recommendations for controls and process improvements to the leadership team.
Follows guidelines in alignment with all health plan requirements as related to the provider certification and credentialing.
Follows all CMS guidelines with regard to both individual and group enrollment, identifying areas of opportunity and sharing them with the leadership team.
Interacts with varied levels of management, physician office staff, and physicians effectively to accomplish credentialing and elements of implementation and launch.
Plans audits by understanding organization objectives, structure, policies, processes, internal controls, and external regulations. Identifies risk areas that support the policy scope and creates audit measures accordingly.
Continuously assesses the Credentialing and Enrollment compliance with company guidelines and external regulations and makes effective recommendations for process improvements.
Identifies gaps in current processes/procedures, completes an analysis, and provides recommendations for policy/procedure revisions and process improvements.
Due to the sensitive nature of quality audits, ensures that audit records and information are maintained in confidence within the Department and communicated only to affected Leadership.
Coordinate and prepare reports for the leadership team.
Record and track credentialing statistics.
Other duties as assigned.
5+ years experience in credentialing and in depth knowledge of NCQA and URAC standards.
Knowledge and experience using Verity CredentialStream software is a plus
Demonstrated skills in problem solving and analysis and resolution
Advanced Microsoft Excel skills
Must be able to function independently, possess demonstrated flexibility in multiple project management
Must comply with HIPAA rules and regulations
Prefer knowledge of EFT, ERA, EDI enrollment and claims systems.
The salary range for this role is $65,000.00-$75,000.00 in base pay and exclusive of any bonuses or benefits. This role is also eligible for an annual bonus targeted at 15%. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.
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We’re seeking a Data Analyst, Business Intelligence who will be a key contributor on our Corporate Analytics team in enabling our clients to make better data driven decisions on financial, operational, and clinical initiatives. This role covers internal and external customers and requires working cross-functionally to understand evolving business needs and requirements. This Privia Partner will be responsible for helping to design and develop reports, presentations, and models to guide strategic decision making of our stakeholders. The Analyst works to deliver data-driven insights to key stakeholders across the enterprise. The Analyst assists in the development of end-to-end analytics solutions efforts, working with cross-functional teams to deliver on evolving requirements and business needs, build scalable reports and applications, and deliver solutions that ultimately empower end-users in making data-driven business decisions. The Analyst also supports the execution of business- and client-facing ad hoc analyses, using data to guide strategic discussions among and between internal and external stakeholders.
Primary Job Duties:
Originates and maintains custom programming projects, programming integration projects, and data extraction. Fluent in SQL and will mine data from Privia’s data warehouse for the purposes of supporting complex operational analyses
Conduct ad-hoc analyses across a multitude of business issues, including pop health, revenue cycle management, payer contracting, and financial domains
Collaborate with our Revenue Optimization and Payer Contracting teams to develop reports and alerts that will ensure that Privia is being paid appropriately for our fee-for-service and pay-for-performance contracts
Analyze dashboards and reports for trends in KPIs and work with our Operations team to make appropriate changes to our delivery system to optimize throughput and profit
Translate business requirements into technical specifications
Work closely with the Product Engineering team to ensure quality of database build prior to deployment
Perform other duties as assigned
Bachelor’s degree in a quantitative field (Economics, Finance, Statistics, Mathematics, Computer Science, etc.) or equivalent experience, preferably in healthcare
2+ years experience using SQL
2+ years experience using Python
Expert-level Microsoft Excel skills, including pivot tables and advanced formulas
1+ years experience working with healthcare claims data
Strong project management and analytical skills, including a desire to logically solve business and technology problems
Preferred experience with BI tools like Tableau, MicroStrategy, QlikView, or Looker (or willingness to learn)
Preferred experience in an Agile Sprint environment
Must comply with HIPAA rules and regulations
Interpersonal Skills & Attributes
Innovative, resourceful, and outcome-driven
Ability to successfully manage multiple competing priorities
High attention to detail and quality control
Strong verbal and written communication skills
Excellent critical thinking skills and proven track record with presenting quantitative information to stakeholders
The salary range for this role is $75,000-$95,000 in base pay and exclusive of any bonuses or benefits. This role is also eligible for an annual bonus targeted at 15%. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.
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The Provider Recruitment Associate will support the growth of Privia Health by assisting the Provider Recruitment team with the logistics of the recruitment process to result in the successful placement of physician and advanced practitioner candidates within our practices (care centers).
The hourly range for this role is $20.00-$26.45 in base pay. This role is also eligible for a variable compensation plan. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.
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TheGrowth Strategy & Analytics Analystis responsible for overseeing all financial modeling and valuation initiatives for our Privia Medical Group (PMG) clients nationwide. As a member of the Growth Strategy organization, the ROI Analyst provides financial analysis support that enables Privia stakeholders and prospective practices to make business decisions that drive overall business results and facilitate growth of the company.
Primary Job Duties:
Interpersonal Skills & Attributes:
The salary range for this role is $65,000-$75,000 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.
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The Coder+ Quality Assurance Specialist will be accountable for executing the quality assurance program related to CODER+ services provided by Privia Health. The QA Specialist will serve as an integral member of the CODER+ program team, responsible for partnering with vendor partners and internal coders to ensure high quality coding is being performed and that proper feedback is being given. This position will spend the majority of the time reviewing coders, educating coders, and working on various projects that involve coding and education. The ideal candidate will draw on existing expertise in primary care and specialty medical coding, billing and compliance with government and commercial payers and act as a coding resource within the team. The Quality Assurance Specialist will perform Evaluation and Management coding, procedure, ICD-10 and HCPC quality reviews as well as other projects related to physician coding. The ideal candidate demonstrates a thorough understanding of complex coding and reimbursement as they relate to physician practices and clinic settings.
Job Requirements:
The salary range for this role is $65,000.00 to $75,000.00 in base pay. This role is also eligible for an annual bonus targeted at 10% based on the performance for the role. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.
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Reporting to the Director, Compliance & PMG Compliance Officer, the Compliance Manager will ensure all required elements of an effective Compliance Program are met. This position will be responsible for assisting with execution of our compliance plan and the organization’s compliance education program. The Manager, Compliance will assist in review and development of processes and controls to ensure compliance with state and federal laws and regulations applicable to Privia Health.
Serve as a Subject Matter Expert in health care compliance and maintain a current knowledge of healthcare legal and regulatory requirements and industry standards
Research Federal and State regulations and payor contract requirements on assigned compliance topics
Partners and collaborates with the Compliance Department, senior leadership, and legal counsel to develop guidance on all new and current business initiatives
Assist in the implementation of Privia’s Compliance Program in new markets
Assist in responding to regulatory and payor audit requests
Assist in the management of the day-to-day compliance program
Assists in the development, modification, communication, and implementation of policies and procedures
Assist Sr. Director, Audit & Compliance with managing and maintaining organization’s policy and procedure tool
Assists in the development and execution of annual compliance and monitoring plans, including performing the risk assessment and implementing corrective action plans where needed
Coordinate with the Coding Compliance and Integrity Team to ensure appropriate action plans are in place and monitored
Work with Compliance, Legal, IT Security and Training teams to maintain compliance education and training materials
Perform internal compliance audits and investigations as assigned, including risk-based audit program development, testing and drafting results
Collaborate with departmental management to develop formal corrective actions to ensure compliance
Support the Sr. Director, Audit & Compliance in preparation and delivery of reports to various stakeholders and Executive Management team
Perform tasks assigned by the Market Compliance Committees
Participate in Compliance Committee meetings and assist in the preparation of related materials.
Assists the Sr. Director Audit and Compliance with compliance special projects
Experience with ACO’s is beneficial
Perform other duties as assigned
Bachelor’s Degree preferred or relevant equivalent experience
5+ years’ experience in healthcare compliance with a keen understanding of compliance risks
Knowledge of laws regulations impacting healthcare; Able to review and understand regulations and guidelines and apply them to business practices
Compliance Certification (CHC, CHPC, CHRC, or CHC-F) preferred
Must comply with HIPAA rules and regulations
The salary range for this role is $95,000 to $115,000 in base pay and exclusive of any bonuses or benefits. This role is also eligible for an annual bonus targeted at 15% & restricted stock units. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.
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Location:Remote, with National Travel Expectations
Travel: Up to 75%
We are currently recruiting a Workflow Associate to join our rapidly growing Practice Integration team. The successful candidate will be responsible for workflow design and athenaOne configuration for our enterprise clients and new markets.
Primary Job Duties:
Collaborate with the project team to perform current state workflow assessments and develop training plans for large Care Centers based on findings.
Work with Care Centers to define their own best practices and design workflows that fit
their needs.
Communicate and teach Privia's best practices when appropriate.
Conduct training sessions for key stakeholders and end users
Assist in efforts to improve or redesign the training program at the national level
Assist in the development of web-based eLearnings and knowledge library
Create and report on KPI trends and performance, highlight key insights and strategize on opportunities to improve end user efficiency.
Acts as a SME for Privia Health’s technology platform and workflows and liaison to other Privia stakeholders.
Bachelor’s degree Preferred or relevant equivalent experience
1+ years in an Ambulatory EHR environment preferred
Knowledge of athenahealth’s suite of tools preferred
Previous healthcare operations experience; working with physicians and medical group staff preferred
Tech savvy
Willing to travel locally and nationally
Must comply with HIPAA rules and regulations
Interpersonal Skills & Attributes:
Functions independently and autonomously, but works well within a team environment
Extremely bright and analytical; turns the unknown into knowledge in short order
Skilled in establishing and maintaining effective working relationships with providers, management, clients and staff, in order to get buy-in to decisions
Ability to think on your feet and troubleshoot technology issues under pressure
Expresses ideas clearly and effectively, motivates the listener to action
Responds calmly and maturely in high pressure situations
Positive attitude toward company, work, clients, management, and team members
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We are always seeking top talent for the After Hours Care Manager position and are currently reviewing resumes. If you meet the qualifications and are interested in future opportunities, we encourage you to appl
We are actively recruiting for an After Hours Care Manager to join our rapidly growing Population Health team. The primary role of the Care Manager will be to provide our patients with on-demand telephone-based care management services through a 24/7 Nurse Advice Line (i.e. telephone triage). Care Managers will assess symptoms/concerns of callers to determine the urgency and type of care needed, refer to or schedule appointments with providers as appropriate, and give health information and advice to callers. The goal of the Nurse Advice Line is to reduce unnecessary visits to the clinic and emergency department, provide information for self-care and symptom management, and to coordinate care across the healthcare delivery system. Care Managers operate in a team-based model, acting as an extension of the primary care provider.
Primary Job Duties:
Handles inbound communications from patients who are seeking information about symptoms or care concerns
Conduct outbound communications for follow-up and care coordination
Consult and coordinate with internal and external team members to assess, plan, implement and evaluate patient care plans, make appropriate referrals, and provide follow-up
Assist with finding appropriate providers, community resources, care solutions and coordinate priority appointments
Record member data in Privia’s web-based medical record system and associated EMRs, or health portals.
Research information online and in Privia’s internal knowledge databases
Provide health information, coaching, and critical thinking skills to assist our members with medical and wellness related issues
Other care management activities as needed (e.g. close “gaps in care,” complex care plans, etc.)
Must comply with HIPAA rules and regulations
This part-time role is primarily available for Nights, Weeknights and Holidays (9pm-9am EDT) , with flexible and alternating shifts (2, 4, 8, 6, 10 & 12 hours).
Must maintain “on average” at least 16 hours of nights and/or weekend coverage)/week or 64 hours/month. Weekend times span from Friday, 9p EDT - Monday, 9a EDT. Flexible time off as needed.
Privia will help set up the home office setting with computers, high speed internet access and other equipment needed for the role.
Registered Nurse (RN) with current resident compact licensure in assigned state(s).
Bachelor’s degree, at minimum
Experience in a call center, triage position, consulting environment or like environment.
Minimum 3-5 years of recent clinical experience, with problem-solving and critical-thinking skills
Disease Management, Case Management, Utilization Review or Wellness experience
Without question, 'Exceptional Customer Service'
Strong computer skills. Internet savvy
Clear, confident communication and listening skills
Self -motivated and self-disciplined a must
Willingness to do what it takes to get the job done and make patients the number one priority
Able to thrive in a quiet, secure home office environment
Detailed-oriented, organized with the ability to work well in fast-paced work environment
Bilingual – Spanish, Korean, Vietnamese, or Farsi preferred
The hourly rate range for this role is $24.00- $30.00hr in base pay. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.
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