Senior Coding Analyst, Risk Adjustment

Altais•Remote - CA, CA

1d•$25 - $30

About The Position

The Senior Coding Analyst, Risk Adjustment, divides time between coding medical records for HCC coding, including annual health assessments, and working with physicians on clinical documentation improvement. The role supports risk adjustment and data validation programs for the Medicare Advantage line of business, as well as other projects assigned by Clinical Performance leadership. The work affects revenue and supports readiness for health plan, CMS, and HHS audits. The analyst provides analytics, education, and training to provider offices and serves as a subject matter expert on HCC coding initiatives, policies, and procedures in accordance with organizational coding guidelines and compliance standards. The position interacts with physicians, the provider network, and internal stakeholders such as Provider Relations and Clinical Quality, and requires developing and maintaining relationships across the organization and provider network. The role may expand to include Commercial, Medicaid, Quality, and Social Determinants of Health (SDoH) capture. It may involve spending 50% or more of the time meeting production standards.

Requirements

High school diploma or GED and the equivalent of 2 years of relevant HCC coding experience.
3–5 years of experience with professional medical coding credentials such as CPC, CRC, or similar.
3–5 years of HCC coding and auditing (chart review) experience.
At least 1 year of experience using EPIC EMR software.
3–5 years of Medicare Risk Adjustment experience.
At least 1 year of project management experience and/or experience coordinating detailed projects or activities.

Nice To Haves

Bachelor’s degree from an accredited school.
6 or more years of experience in a clinic setting working directly with physicians and staff.
6 or more years of experience and knowledge of Commercial and Medicaid coding and SDoH.

Responsibilities

Review, audit, and code medical records for HCC reimbursement, training, education, and compliance.
Meet daily HCC coding productivity targets with 95% accuracy, as well as office outreach and education targets.
Audit and review medical documentation for appropriate ICD-10 and HCC coding and documentation.
Query physicians when code assignments are not straightforward or documentation is unclear.
Review HCC and ICD-10 codes annually for accuracy and implement changes.
Assist physicians and providers with questions and problems related to HCC coding and documentation.
Support organizational HCC coding audits, including Internal Data Validation (IDV), Risk Adjustment Data Validation (RADV), Office of Inspector General (OIG), and Department of Managed Healthcare (DMHC) audits.
Serve as a resource to team members and physician offices.
Provide analytics, education, and training to provider offices and act as the subject matter expert for HCC coding initiatives, policies, and procedures.
Work with physicians on clinical documentation improvement and support risk adjustment and data validation programs.