Remote Medicare Risk Adjustment Coding/ Auditor (Prior CMS-HCC V28 required)

Alignment Health•Remote CA Outside Bay Area, CA

12d•$64,384 - $96,577•Remote

About The Position

Alignment Health is seeking a remote Medicare Risk Adjustment Coding/Auditor. This role supports departmental Quality Assessment audits of internal Coding Analyst team and vendors to ensure accurate and complete data is submitted to CMS. The position assists in Risk Adjustment related data audits (RAF, prevalence, clinical documentation improvement, P360, process) to identify areas of opportunity for improvement, such as training, data integrity, and chart reviews. Alignment Health is committed to serving seniors and the chronically ill and frail, offering opportunities for growth and innovation in a fast-growing company where employees can do work that truly matters.

Requirements

Minimum three years of Medicare Risk Adjustment coding in a medical group or health plan setting required.
High School Diploma or GED.
Completion of a Medical Coding training program.
Technical School or courses that are required to become a certified coder.
Proficient user in MS office suite – Excel, Word, Outlook.
Previous use of Epic, Allscripts, EZCap, Athenahealth.
Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors.
Ability to perform mathematical calculations and calculate simple statistics correctly.
Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.
Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
Comprehend and analyze statistical reports.
Certified Coder required, CCS, CCS-P, CPC, CRC, RHIT or RHIA.

Nice To Haves

Bachelor’s degree in Business Administration, health Care Management or in a related field.

Responsibilities

Supports regular quality assurance (QA) audits of internal Coding Analyst Team to validate and confirm coding & abstracting quality (95% HCC accuracy).
Tracks and reports progress of QA audits performed on the coding vendors to verify the coding accuracy and quality of the data submitted to AHP is accurate for submission to CMS.
Works with Risk Adjustment Management on any MRA data validation / coding audit to ensure completeness and coding accuracy of all submissions to CMS.
Analyzes and shares audit results with Manager, which may be used for training physicians and clinical staff, documentation improvement, and system / process improvement.
Utilizes, protects, and discloses Alignment Healthcare patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
Ensures compliance with all applicable federal, state & local regulations, as well as with institutional/organizational standards, practices, policies & procedures.
Maintains professional / technical knowledge by attending appropriate educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies.
Stays current of industry coding, compliance, and HCC issues.
Maintains relevant continuing education units (CEUs) in relation to individual coding certifications.
Performs other duties as assigned to meet the organization’s needs.