Job Description

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.

• Maintain accurate records by updating the provider audit and education tracker with new providers/care centers.
• Monitor and track the completion of education pre- and post-audit to begin audits.
• Create and assign audits to auditors based on the audit schedule and availability
• Map and update new facilities and providers, regularly review provider mappings in MD Audit software, and update as necessary.
• Manually upload claims for initial and follow-up audits when necessary.
• Request medical records if needed for audits.
• Sends audit results reports to the appropriate stakeholders.
• Monitors the coding questions Monday Board and assigns them to the appropriate auditor.
• Other duties as assigned

Qualifications

• Minimum 4 years of experience in coding compliance audit support functions.  
• Basic knowledge of ICD-10, CPT, and HCPCS coding.
• Basic understanding of healthcare regulations and guidelines (e.g., CMS, OIG)
• EHR experience required
• Strong organizational and data entry skills.
• Attention to detail with a focus on accuracy and compliance.
• Good communication skills, both written and verbal.
• Ability to multitask and handle shifting priorities in a fast-paced environment.

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.

See more jobs at Privia Health

Apply for this job

Job Description

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.

Qualifications

• 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.

See more jobs at Privia Health

Apply for this job

Job Description

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

Qualifications

• 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.

See more jobs at Privia Health

Apply for this job

Job Description

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).

• Develop and maintain a working knowledge of our practice model and regional communities in order to assist with candidate inquiries
• Work with physician recruiters to profile new requisitions and develop practice opportunity descriptions
• Work with physician recruiters to identify, source, pre-screen and schedule for further evaluation qualified candidates (APP’s and Physicians) for open requisitions
• Manage sourcing activities for all open requisitions and log activities in the applicant tracking system
• Manage outbound communication campaigns, including broadcast emails, mailings, and other mass communications for physician and advanced practitioner requisitions
• Provide support to Provider Recruitment Coordinator and physician recruiters with candidate interview processes, both telephone interview and site visit coordination, which may include arrangements for travel, lodging, etc.
• Assist in the development and ordering of physician recruitment marketing collateral
• Support off-site recruitment events, such as regional and national conferences
• Develop and maintain provider recruitment resource library
• Establish high-reach objectives, personally track and report on performance
• Ability to travel (20%)
• Other duties as assigned

Qualifications

• Bachelor’s Degree and at least one year related experience preferred
• Previous healthcare, sales, marketing, or recruiting background is preferred with specific knowledge of the medical/physician community
• Strong computer technology skills including, but not limited to, Microsoft Outlook, Microsoft Word, Excel, PowerPoint, SalesForce and social media outlets
• Superior marketing and public relations skills with the ability to communicate clearly and professionally to present practice opportunities in a positive manner
• Proven track record of exceptional customer service skills
• Demonstrated ability to conduct Internet research in an efficient, productive manner
• Must comply with HIPAA rules and regulations
• Excellent communication skills with the ability to engage at all levels of the organization. Demonstrate a professional and adaptable demeanor with internal and external clients, including administrators, physicians, peers, and support staff.
• Exhibit a high energy level, and demonstrate the ability to work as a team, with flexibility in work habits to schedule and meet the needs of the medical staff.
• Proven ability to multi-task, planning and prioritizing a large volume of detail-oriented work in accordance with changing deadlines.

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.

See more jobs at Privia Health

Apply for this job

Job Description

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:

• Prepare ROI models for prospective practices interested in joining PMG
• Collaborate with in market sales team to coordinate collection of data, preparation of models and presentation materials
• Assist in developing and refining models to meet changing understanding of our markets and the broader healthcare industry.
• Perform ad-hoc pro-forma financial analyses to help departments throughout Privia and potential customers answer data related questions with limited oversight.
• Foster relationships and cross-functional support between the finance, sales, analytics, and payer teams.
• Strategic thinker who assesses situations carefully and delivers scalable recommendations and results.
• Perform other duties as assigned

Qualifications

• Bachelor’s Degree in Finance, Accounting, Economics or Business degree and Master’s degree preferred
• 1+ years of work experience; Healthcare experience in audit, consulting or a healthcare quantitative field is strongly preferred
• Excel experience required
• Technically savvy; Able to pull reports from several different practice management systems
• Must comply with HIPAA rules and regulations

Interpersonal Skills & Attributes:

• Able to be client facing and think critically about the data that is obtained from clients and prospective clients.
• Ability to work in rapidly growing environment, with excellent attention to detail, multitasking and organizational skills
• Strong communication skills
• Ability to handle high levels of pressure and apply critical decision making with constantly shifting priorities

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.

See more jobs at Privia Health

Apply for this job

Job Description

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:

• Apply appropriate coding classification standards and guidelines to medical record documentation for accurate coding
• Perform quality assessments of records, including verification of medical record documentation (electronic and handwritten)
• Perform quality assessments of coders completed work to validate standards are met
• Research and answer coding and coding workflow related questions for providers and clinic staff
• Meet with providers and clinic staff as needed
• Educate coders and other staff on appropriate coding guidelines
• Assist in development and ongoing maintenance of processes and procedures for each assigned client
• Collaborate with internal Privia+ and Privia teams
• Collaborate with vendor partners
• Follow coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies
• Assist in the Privia+ day-to-day coding/educational needs as needed
• Other duties as assigned

Qualifications

• 5+ years of provider medical coding experience across medical and surgical specialties
• 3+ years experience in coding audit or quality review work
• AAPC Certified Professional Coder (CPC) certification required
• CPMA preferred 
• Athena EMR experience preferred 
• Experience working in a physician practice setting strongly preferred
• Ability to work effectively with physicians, advanced practice providers (APP), practice staff, health plan/other external parties and Privia multidisciplinary team
• Extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codes.
• Must comply with HIPAA rules and regulations
• Passion for efficiency and a drive to reduce redundancy
• Professional, clear, and concise oral and written communication
• Knack for prioritizing efficiently and multi-tasking
• Self-directed with the ability to take initiative
• Competent in maintaining confidential information
• Strong team player with ability to manage up members of team to encourage partnership and cooperation with clinic staff

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.

See more jobs at Privia Health

Apply for this job

Job Description

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

Qualifications

• 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.

See more jobs at Privia Health

Apply for this job

Job Description

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.

Qualifications

• 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

See more jobs at Privia Health

Apply for this job

Job Description

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

Qualifications

• 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.

See more jobs at Privia Health

Apply for this job