Risk Adjustment Provider Engagement Lead - Remote

Alignment Health • Remote CA Outside Bay Area, CA

5d • Remote

About The Position

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. This is a remote position. The Risk Adjustment Provider Engagement Lead is responsible for building relationships with our external physicians while conducting medical record reviews, monitoring, and analyzing coding patterns, and providing onsite education. Provide coding expertise as well as administrative oversight to improve the overall quality of the documentation; ensuring that it is to the highest level of specificity in accordance to the CMS guidelines.

Requirements

• Three-five years of coding in a medical group or health plan setting required
• Professional Coding experience required.
• Experience with strategic planning in risk mitigation.
• Bachelor’s degree in business administration, health care management or a related field or equivalent experience
• Current driver’s license
• CPC, CPC-H, CCS, CCS-P, RHIT, RHIA, OR CPMA

Nice To Haves

• Proficiency in MS Officer suite including Access
• Previous use of Epic, Allscripts, EZCap a plus
• Nursing degree

Responsibilities

• Validates provider documentation for accuracy by reviewing and analyzing samples of coding and claims extracts compared to actual medical records.
• Develops education materials to assist physicians in accurately assessing patients’ overall health status.
• Provides feedback to providers on performance improvement opportunities; tracks and prioritizes projects to improve coding and documentation outcomes.
• Maintains a comprehensive tracking and management tool for assigned physicians within Alignments Healthcare provider network.
• Identifies issues, determines impact to risk adjustment models, and reports results timely to ensure that physicians remain in compliance.
• Collect, analyze, and share MRA performance data through clear presentations and detailed reports, including outreach priorities, HCC gap data, and encounter status insights for use through Joint Working Groups (JWGs) with internal and external stakeholders.
• Collaborate with internal and external coding, analytics, and clinical teams to ensure accurate and complete diagnosis coding and HCC Gap Closures.
• Presents progress and results to leadership on a routine basis.
• Assists with CMS Risk Adjustment Data Validation activities to ensure our external physicians and Alignment Healthcare is prepared for and will pass an audit.
• Regularly updates all Risk Adjustment materials with clinical and/or official guideline changes.
• Suggests, updates, and enhances clinical educational materials to assist in training physicians and clinical staff on Risk Adjustment Healthcare Programs including CMS-HCC Models, Clinician Chart Reviews, and Encounter Documentation.
• Suggests customizations of Risk Adjustment education for various audiences; Support Staff, PCPs, Specialists, Employees vs. contracted and Central Departments
• Stays current on industry coding, compliance and HCC issues.
• Utilizes, protects, and discloses Alignment Healthcare patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies.
• Local travel is required

Benefits

• Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree