• Conducts live field ride-alongs with commercial field representatives and field medical staff to assess compliance with policies and regulatory requirements. • Observes healthcare professional (HCP) interactions to ensure alignment with approved labeling, promotional standards, and company policies. • Evaluates adherence to Company guidelines including but not limited to meals with HCPs, educational materials, and appropriate messaging. • Prepares detailed monitoring reports summarizing observations, risk findings, and recommended corrective actions. • Conducts live monitoring of speaker programs, ad boards, steering committees and other events to assess compliance with company policies and industry standards. • Evaluates content delivery, adherence to planned agendas, attendee appropriateness, event logistics and other pertinent risk areas associated with these types of events. • Documents findings and collaborates with appropriate departments on remediation plans as needed. • Assists in creating monitoring plans to assess compliance risk areas for the business. • Performs desktop monitoring based on the monitoring plan of Company activities using internal systems and data analytics. • Reviews data related to emails, expenses, call notes, speaker programs, meals, etc. as required by the annual monitoring plan and in collaboration with manager. • Identifies trends, red flags, and potential areas of risk. • Develops monitoring dashboards and analyze metrics to identify trends and assess the effectiveness and efficacy of monitoring activities. • Prepares periodic compliance reports for leadership. • Conduct ad-hoc reviews, inquiries and investigations as required by the Director, Ethics & Compliance on risk areas or compliance violations as they arise. • Assist in developing and delivering compliance training as needed. • Support enhancements to monitoring methodologies and standard operating procedures. • Assist Auditing Lead with Transparency / Aggregate Spend Oversight including data collection, reconciliation, and accuracy of HCP/HCO spend for federal/state reporting. • Identify process gaps and drive improvements in data flow, documentation, and reporting governance.

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 Under indirect supervision, the Coding Compliance Audit/Education Specialist audits medical records for compliance with federal coding regulations and guidelines. Successful candidates will have extensive knowledge of auditing and education on CPT, ICD-10, and HCPCS codes and guidelines. - Conduct audits (i.e. baseline, routine periodic, and focused) comparing medical record documentation to reported CPT/HCPCS and ICD-10-CM codes with consideration of applicable federal and state laws, regulations, and guidelines. - Research, interpret and communicate federal and state laws and guidelines pertaining to CMS and Medicare. - Acts as an internal expert on coding issues to ensure compliance with state and federal regulations. - Preparation of audit reports including summary of findings - Conduct post-audit provider education with individual or large provider groups - Schedule trainings with provider’s offices, individual providers and groups of providers - Provides feedback, initial and ongoing education and training, and technical support with regard to proper documentation guidelines, service selection, charge capture, supervision, timely submission, healthcare data accuracy, and coding principles. - Communicates audit findings to providers to track education completion and escalation. - Interacts professionally and effectively with physicians, leaders, staff, and internal teams. - Provides coding assessment, consultation, education, and issue resolution to key stakeholders as requested. - Able to have honest, difficult conversations with providers about compliance, documentation, and code assignment. - Other duties as assigned Qualifications - 5+ years of audit and provider education experience is preferred. - Extensive knowledge of CPT, ICD-10, and HCPCS codes and guidelines. - Certified Professional Coder (CPC) and Certified Professional Medical Auditor (CPMA) required. - Experience working with MDAudit and Athena is a plus. - Must comply with all HIPAA rules and regulations. - Excellent communication skills and the ability to work independently. The salary range for this role is $70,000.00 to $80,000.00 in base pay and exclusive of any bonuses 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 15%. 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: Audit & Coding

Role Description Facilitate accreditation related tasks and work closely with internal and external team members to ensure the pharmacies meet accreditation requirements. Assist as necessary to support accreditation compliance and quality initiatives. Position Location: Work From Home based position Responsibilities - Work in conjunction with internal and external team members to ensure compliance with service expectations and achievement of performance goals and objectives for each pharmacy seeking or maintaining accreditation. - Confer with management, supervisors and employees to gain knowledge of work situations requiring training and to better understand changes in policies, procedures, regulations, and/or business technologies as it relates to improving or establishing accreditation compliance. - Assist with staff training and the implementation of processes related to meeting accreditation standards including requirements for Continuous Quality Improvement, Performance Improvement projects, Quality Management, and compliance with all accreditation standards. - Prepare reports and maintain records as requested or required. - Participate in internal and external meetings and complete associated tasks as required. - Participate and support regional and enterprise level activities as required. - Participate in the maintenance of corporate compliance and legal board of pharmacy inspection parameters. - Perform timely resolution to requests received from internal departments, customers, audit entities, or regulatory. - Closely monitor current processes and Standard Operating Procedures (SOP's) to maximize efficiency and support accreditation compliance. - Promptly report any allegations of impropriety to the Compliance Department. - Comply with VytlOne's Ethical Business Conduct policy and VytlOne's Compliance Program. - Remain free from exclusion under the OIG and SAMS Medicare/Medicaid lists. - Complete required training, as assigned, within the established timeframes. - Must be able to cope with the mental and emotional stress of the position. - Maintain regular attendance in accordance with established policies. - Perform other job-related duties as assigned. Qualifications - College coursework is desirable and any combination of the necessary knowledge, skills, and abilities necessary to competently perform the essential functions of the position. - Current, unrestricted National and/or State Certified Pharmacy Technician license. - Minimum 3 years’ experience in compliance, healthcare, quality, and/or accreditation required; experience with ACHC and/or URAC specialty pharmacy accreditation required. - Knowledge of pharmacy accreditation requirements such as ACHC and URAC Specialty Pharmacy Accreditation. - Knowledge of generally accepted pharmacy principles, practices and procedures. - Work effectively in a team environment and communicate well using virtual tools when team members are geographically dispersed. - Must be detail oriented, be able to work independently, and possess self-motivation skills. - Work effectively in situations with limited information and moderate ambiguity. - Ability to communicate effectively orally and in writing, to interact with a wide variety of individuals to successfully provide optimal pharmacy support. - Ability to work with close attention to detail and minimal errors. Must be alert, attentive, and precise. - Working knowledge of Microsoft Office and willing to learn Smartsheet, Confluence, and other tools as necessary. - Excellent critical thinking and problem-solving skills. Benefits - Comprehensive mental health and wellbeing resources. - Nationwide Blue Cross Blue Shield PPO with employee-friendly plan design, including a $850 individual annual medical deductible and $25 office visit copays, with low biweekly premiums. - Company-paid basic life/AD&D, short-term and long-term disability insurance. - Rx, dental, vision, other voluntary benefits, and FSA. - Employer-matched 401k Plan. - Industry-leading PTO plan. - And more! Company Description Founded in 1926, VytlOne (formerly Maxor National Pharmacy Services) is a leading, independent pharmacy solutions platform that improves prescription drug affordability and outcomes. Over time, VytlOne has built a unique and complementary suite of services and technology offerings that deliver clinical, financial and strategic value to patients, payors and providers across the pharmacy supply chain. VytlOne has a proud heritage of growth and innovation earned over the decades. Amarillo, Texas is the legacy headquarters for VytlOne but our talent base is national. We operate pharmacies and other business operation sites across the United States with employees working from 47 states. Pharmacies are essential to healthcare, with nearly 90% of the US population living within 5 miles of one and seeing their pharmacist an average of 12 times a year. Providing a positive patient experience is crucial to ensuring patients adhere to their therapies. At VytlOne, we recognize that our employees are our most valuable assets. We actively seek and retain talented professionals who are mission-driven to improve healthcare outcomes for patients. Our employees are essential to their own well-being, finding fulfillment in meaningful work, competitive compensation, diverse and inclusive teams, and limitless career possibilities. With a workforce of 1,600+ and almost a century of pharmacy experience, we offer the stability of a Fortune 500 company and the energy and innovation of a startup. Our expertise and technology support the entire pharmacy ecosystem, but our impact goes beyond pharmacy services.

Role Description Join our team and make a positive impact on the lives of others! We are looking for a Manager of Compliance Audit for our Compliance team. This role is remote with potential travel to our main office in Long Island, NY and/or the FreedomCare hub closest to you. The Manager of Compliance Audit is responsible for keeping FreedomCare compliant with all new and updated healthcare regulations. This role is responsible for: - Auditing organizational compliance. - Making recommendations and implementing processes to improve compliance. - Overseeing a team of compliance personnel dedicated to auditing and enforcing compliance standards at FreedomCare. - Monitoring and improving efforts to fight fraud and uphold compliance standards. Every Day You Will: - Oversee and manage compliance team daily operations to ensure efficient work distribution and enforcement of compliance standards at FreedomCare. - Work with leadership to improve processes to drive stronger compliance. - Oversee internal compliance audits and design protocols for compliance with regulations and FreedomCare standards. - Support any external audits. - Be a resource for compliance concerns and escalations; communicate changes in policies or procedures. - Work with IT to ensure proper security solutions for HIPAA compliance. - Routinely monitor state and federal regulations and update internal policies accordingly. - Track company compliance with HIPAA. - Coordinate annual required compliance training with Learning & Talent Development. - Recommend decisions within policies that impact service levels and team objectives. - Supervise a team of non-exempt support or junior level professional staff; set priorities for employees. Qualifications - Bachelor’s degree and a minimum of 5 years related experience. - Extensive knowledge of regulations relating to Medicaid and/or audit or compliance experience. - Two to four years of prior leadership experience strongly preferred. - Experience implementing policies and procedures. - Experience managing a team within a customer-centric, healthcare environment. - Extensive knowledge of Billing and Coding preferred. - Ability to exercise good judgment in decision making using knowledge of best practices and regulations. - Ability to work independently with limited supervision on complex matters; self-starter and takes initiative. - Demonstrated ability to be detail-oriented and thorough; comfortable with developing effective processes for tracking information. - Reliable and detail-oriented. - Ability to collaborate effectively with people at all levels; excellent communication skills, both verbal and written. Benefits - Competitive compensation. - Medical benefits. - Retirement plans. - Wellness programs. - Fun company events. - Ongoing learning opportunities to grow your career.