Risk Adjustment Documentation & Coding Educator (CRC Required)

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