[Hiring] National Director, Risk Adjustment @Privia Health

Role Description

The National Director, Risk Adjustment identifies and implements initiatives to achieve complete and accurate coding goals across all markets. This role collaborates and communicates extensively with Market and Provider Clinician Leadership to identify improvement opportunities, establish clear goals, and facilitate the implementation of effective solutions that are scalable with repeatable outcomes.

• Collaborate with Market and Provider Leadership and market SMEs to identify opportunities and tactics to improve complete and accurate coding performance.
• Document specific goals and facilitate discussion and discovery of solutions across markets.
• Lead and/or facilitate the implementation of processes across all markets.
• Manage projects to enable complete and accurate coding, including vendor assessment, contracting, implementation, and management.
• Coordinate clinician and Privia market and national teams.
• Cultivate collaborative relationships with key stakeholders across RCM, Finance, Platform Engineering, and other departments.
• Partner closely with data and technology teams to improve timely and meaningful reporting and insights at the point of care.
• Serve as the internal subject matter expert on the current Hierarchical Condition Category (HCC) Risk Adjustment models.
• Responsible for the management of one or more staff members and their professional development.
• In partnership with Privia’s Compliance leader, maintain a focus on coding compliance.
• Develop models for chart review, audit, and education that minimize risk and promote thorough patient care.
• Conduct training with individual and large provider groups, particularly in new markets.

Qualifications

• Bachelor’s degree required.
• Minimum of 3 years experience in leadership position in risk adjustment.
• Certified Professional Coder (CPC) required; CPC and Certified Risk Adjustment Coder (CRC) preferred.
• Knowledge of Federal laws and regulations affecting risk adjustment documentation and coding compliance.
• Extensive knowledge of documentation and coding guidelines established by CMS and AMA.
• Familiarity with Electronic Medical Records (athenahealth preferred), Encoder, Coding Clinic, G-Suite, and other software programs.
• Understanding of healthcare billing compliance, including prevention of upcoding and other regulatory requirements.
• Maintain patient, team member, and employer confidentiality; comply with all HIPAA regulations.

Requirements

• The salary range for this role is $125,000.00-$150,000.00 in base pay, exclusive of any bonuses or benefits.
• This role is eligible for an annual bonus targeted at 20% and restricted stock units.
• The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

Benefits

• Medical, dental, vision, life, and pet insurance.
• 401K.
• Paid time off.
• Other wellness programs.