*Candidate must have direct experience working on the Centers for Medicare & Medicaid Services Risk Adjustment Data Validation (CMS RADV) contract. *Day time availability is required due to meetings Position Summary The Coding Compliance Specialist is responsible for overseeing and evaluating assigned Risk Adjustment Data Validation (RADV) medical record review (MRR) work performed under the contract. This role ensures compliance with CMS RADV guidelines, coding standards, and risk adjustment policies while maintaining the highest quality and accuracy in medical record documentation. This is a part-time, remote position with flexible scheduling, ideal for experienced professionals seeking autonomy and work-life balance. Key Responsibilities - Ensure adherence to CMS RADV payment and risk adjustment policies. - Provide expert guidance on coding and documentation standards, including ICD-CM, HCC, and Risk Adjustment. - Review escalated Medicare RADV medical record cases and resolve complex issues. - Maintain quality assurance and compliance across all RADV review activities. - Collaborate with stakeholders to improve processes and ensure contractual obligations are met. - Conduct medical record, coding, and policy research. - Develop and deliver training programs related to RADV and coding compliance. - Perform medical record reviews involving PHI/PII, identify conflicting documentation, and provide coding clarifications. Experience Requirements - Prior experience working directly on the CMS RADV contract is required - Minimum 5 years of supervisory experience in medical record review, preferably RADV. - Proven expertise in reviewing escalated Medicare RADV medical record cases. - In-depth knowledge of RADV Medical Record Review (MRR) processes, ICD-CM coding standards, CMS RADV payment and risk adjustment policies, and documentation guidelines. Education & Certification - Medical Coding Certification from an accredited entity (e.g., AAPC, AHIMA). - RHIT, RHIA, CCS, CPC, CRC - Advanced knowledge of coding systems and compliance regulations. Skills & Competencies - Strong analytical and problem-solving skills. - Excellent communication and leadership abilities. - Detail-oriented with a commitment to accuracy and compliance. - Ability to manage multiple priorities and meet deadlines.

Company Description 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 Job Description The RCM Training and Workflow Associate delivers comprehensive virtual athenaOne Collector/Billing training to Care Centers during implementation and post live. This role involves triaging stakeholder issues and requests, and ensuring athenaOne collector training aligns with best practices. The associate maintains current knowledge of new features in athenaOne’s Collector, Clinicals, and Communicator products to optimize workflows for Privia Medical Group Care Centers. The RCM Training and Workflow Associate actively seeks feedback to continually elevate Privia’s RCM and training program to a best-in-class standard. Job responsibilities: - Lead pre-live and post-live athenaOne Collector/billing training to providers, administrative and billing staff in all markets - Ensures that training is scheduled and delivered on-time - Innovate and create new learning experiences for Care Centers for Privia University (LMS). - Provide onsite Go-Live support for New Market and/or high-profile Care Centers - Offer supplemental training opportunities applicable to all markets. - Works collaboratively with cross functional teams to accomplish goals - Share and effectively communicate new athenaOne features regularly - Provides excellent customer service through creative problem solving and follow through - Other duties as assigned Qualifications - Experience with Revenue Cycle Management and Physician office billing required - 2+ years experience with client facing training preferred - 2+ years experience with practice management systems, one or multiple areas of expertise preferred - Experience with athenaOne’s Clinicals and Collector software preferred - Bachelor’s degree preferred - Demonstrated experience in development and editing instructional material - Knowledgeable about extended medical terminology - Must demonstrate excellent communication, organizational, and time management skills - Must demonstrate strong interpersonal skills to interact positively and productively with a variety of personnel within teams and across organizational lines - Ability to work in a very fast-paced and changing work environment - Must comply with HIPAA rules and regulations - Collaborative, customer-focused and able to create visible value. - Team approach to working with others, ability to perform a variety of duties within any work-day and organizational skills from planning to execution of tasks and projects. - Attention to detail. - Excellent communication and client facing skills. - Excellent organizational skills. The salary range for this role is $60,000,00 to $65,000,00 in base pay and exclusive of any bonus 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. Additional Information 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. - Department: Revenue Cycle

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Assign diagnosis and procedure codes using the appropriate coding classification system on all episodes of care inpatient encounters according to coding conventions, guidelines, and hospital policy, analyzing questionable documentation to ensure the accuracy of the information and resolve identified issues. - Ensure the accurate selection of the principal diagnosis, principal procedure, and all applicable diagnoses and procedures. - Ensure compliance with official guidelines (ICD-10-CM, ICD-10-PCS, and/or AHA Coding Clinic), AHIMA Standards of Ethical Coding, and LifePoint Health Support Center (HSC) policies and procedures. Qualifications - Associate degree in health-related field preferred. - One year of inpatient coding experience in an acute care hospital is preferred. - Certified Coding Specialist (CCS) or Registered Health Information Technician (RHIT) preferred. Requirements - Assign appropriate diagnosis and procedure codes utilizing ICD 10-CM/PCS codes according to the Centers for Medicare & Medicaid Services (CMS) requirements for hospital billing. - Achieve and maintain 95% accuracy on quality reviews and assigned productivity standards. - Maintain knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the coding area. - Follow coding workflows for service type to include addressing compliance reviews. - Submit physician queries when clarification of documentation is needed. - Facilitate a positive working relationship with physicians, nurses, medical staff, and hospital employees to ensure that all work-related encounters are productive. - May assist in training and reviewing the work of other coders for accuracy and efficiency. - Make recommendations to the supervisor, and implement and monitor results as appropriate in support of the overall goals of the department. - Seek advice and guidance as needed to ensure proper understanding. - Assist others with responsibilities and adjust work schedule to meet department needs. - Use independent discretion/decision-making while effectively working remotely. - Attend required educational webinars, conference calls, and other coding seminars, and participate in all formal and informal coding discussions. - Maintain coding education hours and renew annual coding credentials as applicable. - Complete all assigned compliance courses within the designated period. - Conform to AHIMA’s Code of Ethics and Standards of Ethical Coding, LifePoint Attendance Policy, and ensure patient/employee privacy and dignity by maintaining confidentiality with no infractions. - Other related job tasks or responsibilities as assigned. Benefits - The position serves internal co-workers and external customers, clients, and contractors. - Access to and/or work with sensitive and/or confidential information. Physical and Mental Demands The physical demands described here represent those that an employee must meet to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform essential job responsibilities. - Occasionally required to sit for extended periods. - Use hands to finger, handle, or feel objects, tools, or controls. - Reach with hands and arms; talk or hear; taste or smell. - Repetitive motion of the upper body is required for extended use of a computer. - Specific vision abilities require close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus. Work Environment and Travel Requirements The position is remote-based. Travel – none expected. Normal business hours are 8 a.m. – 5 p.m., Monday-Friday. However, schedules may vary by business necessity.

Medical Billing Specialist (Medical, Dental & Anesthesia) – Remote (U.S. Only) Employment Type: Part-Time Location: Remote (U.S. residents only) About the Role We are seeking an experienced Medical Billing Specialist with expertise in claims submission and denial management across medical (primary care and cardiology), dental, and anesthesia services. This role is ideal for a detail-oriented professional who understands payer requirements and drives results by improving first-pass claim acceptance, denial resolution time, and accounts receivable (AR) performance. Key Responsibilities - Submit clean, accurate claims for primary care, dental, and anesthesia services. - Manage and resolve denied, rejected, and underpaid claims, including appeals and payer follow-up. - Review EOBs and remittance advice to identify denial trends and root causes. - Work claims to resolution while meeting defined revenue cycle KPIs (e.g., first-pass acceptance rate, denial turnaround time, AR days). - Utilize eClinicalWorks EMR for charge entry, claim submission, and payment posting. - Verify insurance eligibility, benefits, and authorization requirements. - Communicate with commercial payers, Medicare, and Medicaid to resolve claim issues. - Maintain HIPAA compliance and billing accuracy standards. Qualifications - 2+ years of billing experience across medical and/or dental services, with exposure to anesthesia billing preferred. - Demonstrated success in denial management, appeals, and claims follow-up. - Strong working knowledge of CPT, ICD-10, and ADA coding. - Experience with eClinicalWorks or comparable EMR systems. - Highly organized, detail-oriented, and KPI-driven. Preferred Experience - Multi-specialty billing (primary care; cardiology, dental, anesthesia). - Familiarity with anesthesia-specific billing workflows and modifiers. - Experience managing payer correspondence and formal appeals. - Comfort working toward measurable revenue cycle outcomes. Compensation - Compensation: $18-$22/hour - Benefits eligibility varies based on hours worked.