Risk Adjustment and Quality Educator

Altais

5d•$98,175 - $117,810•Onsite

About The Position

At Altais, we’re on a mission to improve the healthcare experience for everyone—starting with the people who deliver it. We believe physicians should spend more time with patients and less time on administrative tasks. Through smarter technology, purpose-built tools, and a team-based model of care, we help doctors do what they do best: care for people. Altais includes a network of physician-led organizations across California, including Brown & Toland Physicians, Altais Medical Group Riverside, and Family Care Specialists. Together, we’re building a stronger, more connected healthcare system. About the Role Are you looking to join a fast-growing, dynamic team? We’re a collaborative, purpose-driven group that’s passionate about transforming healthcare from the inside out. At Altais, we support one another, adapt quickly, and work with integrity as we build a better experience for physicians and their patients. The Risk Adjustment & Quality Educator is part of the Altais Risk Adjustment & Quality team and provides coding support for Altais’s clinicians. The Educator measures accuracy and general completeness of medical record documentation to assess the appropriateness of code assignments, such as ICD-10-CM and CPT II codes with Federal and State requirements for professional fee billing and medical record documentation. This role requires you to travel to provider offices 75% of the time in Southern California and state-wide as needed.

Requirements

Associate degree or 3+ years of relevant experience
5+ years of related professional Risk Adjustment & Quality education experience required.
2+ years of experience with ICD-10 CM
Experience providing training and education to staff and clinicians using excellent verbal and written communication skills, effective technical skills, have positive demeanor and exhibit professionalism in approach
Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC) required
Awareness of Quality measures and the importance of quality gap closure.
Must demonstrate expertise in medical coding guidelines and regulations, including compliance and reimbursement rules.
A strong understanding of physiology, anatomy and medical terminology.
Expertise in denials management identifying root causes and proposing solutions.
Ability to maintain a high level of integrity and confidentiality of medical information.
Organization skills
Strict attention to details
Detail oriented with excellent written and verbal communication
Unparalleled multi-tasking abilities
Critical thinking skills
Ability to react to resets and changes in a fast-paced environment
Able to learn and work with a variety of different tools and applications required for the role

Nice To Haves

Experienced educator with a strong understanding of the requirements for clinical coding and CPT II billing according to the rules of Medicare, Medicaid, and commercial payers
Electronic medical record and chart review experience

Responsibilities

Manage multiple projects, including coding updates, revenue cycle management-related reporting and analytics and process improvement initiatives with the medical groups.
Accountable for reviewing and assigning accurate CPT II and ICD-10 CM Codes for outpatient and inpatient professional services for the Altais provider network
Ensuring the accuracy of all medical documentation and establishing compliance with the Health Insurance Portability and Accountability Act (HIPAA) and other government regulations
Performs coding analysis and supports end users and business partner’s needs; identifies and communicates coding risk areas, providing mitigation strategies and recommendations to various stakeholders.
Accountable for working with the Director of Risk Adjustment & Quality to address improving processes and tools used to document and code clinical services provided by Altais’s providers throughout the enterprise to meet changing business and regulatory conditions.
Set objectives for documentation and track performance against those objectives with key stakeholders.
Work in partnership with Operation’s administrators to coordinate the development of education programs relative to coding and documentation improvement.
Collaborate with Operation’s administrators and providers to review and update orientation and educational materials, documentation tip sheets and training programs/resources.
Assess Altais’s clinical systems to ensure the accurate and complete capture of clinical information that can be extracted and transmitted to payers, regulators, and other parties.
Collaborate with Legal & Compliance to review proposed regulatory changes and provide subject matter expertise regarding associated impacts to Altais’s clinical operations.
Anticipate and effectively address short- and long-term effects of regulatory and industry standard changes to business processes.
Coordinate with and supports Altais’s leaders in meeting strategic and operational goals concerning documentation, coding, and reporting.
Develops a regular meeting series to provide consistent coding and documentation feedback and training to clinicians.
Collaborate and manage risk adjustment reports and work queues across various verticals
Create process maps and documentation to improve workflows impacting the revenue cycle; evaluate whether process changes improved results; conduct education sessions about new procedures.
Responsible for researching and providing accurate coding for rejected claims; works and resolves charge edit work queues daily.
Acts as primary coding resource for medical groups including abstraction of complex surgical reports.
Must abide by the standards of Ethical Coding and adhere to all official coding guidelines.
Accountable for reviewing coding of hospital-based services.
Attends internal coding review team meetings for continued learning and knowledge advancement.
Utilizes superior customer service to clearly communicate opportunities to improve documentation and coding practices, using knowledge of both government and non-government coding trends and reimbursement rules.
May be accountable for, or assist in, entering demographic and insurance information into the electronic medical record (Epic) for hospital-based services.
May support special projects related to reimbursement analysis, new service line development and electronic medical record implementation