Remote Medicare HCC Coding Analyst | CRC Certification

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.

The Hierarchical Condition Categories (HCC) Coding Analyst will effectively interface with provider partners, to successfully, monitor and implement HCC coding strategies. Audit all RAPS submissions to ensure accuracy in the data provided to Centers for Medicare and Medicaid Services (CMS). Provide coding expertise as well as administrative oversight to ensure successful integration of AHC's HCC initiatives.

• Monitors coding & abstracting quality by conducting & or coordinating ongoing audits to ensure coding quality & performance improvement standards are maintained, achieved & improved.
• Develops, implements, evaluates & improves IPA’s educational tools for their respective providers in order to accurately capture acute and chronic conditions.
• Tracks & reports progress of the audits performed on the coding vendors in order to assure the coding accuracy and quality of the data submitted to CMS.
• Works with Risk Adjustment Management on any Data Validation and /or RADV coding audit to ensure completeness and coding accuracy of all submissions to CMS.
• Maintains a comprehensive tracking and management tool for assigned IPA’s within Alignments Healthcare provider network.
• Tracks all Risk Adjustment activities for assigned medical groups and ensure that all tasks are completed in a timely manner. Correlate activities, processes, and HCC results/ metrics to evaluate outcomes.
• Ensures compliance with all applicable federal, state & local regulations, as well as with institutional/organizational standards, practices, policies & procedures.
• Supports the Risk Adjustment Management Team in scheduling/training activities. Maintain records of training.
• Suggests new Physician Group Risk Adjustment coding initiatives. Participate in SCITs/ Education meetings as needed.
• Coordinates Risk Adjustment audit activities as it relates to the assigned groups. Assist with CMS Data Validation activities, including suggested record selections, tracking and submission, in conjunction with Risk Adjustment Healthcare Management.
• Educates and updates:
  • a. Regularly updates all Risk Adjustment materials for clinical and official guideline changes.
  • b. Updates all education materials based on CMS-HCC Model and ICD-9/ ICD-10 annual changes.
  • c. 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.
  • d. Suggests customizations of Risk Adjustment education for various audiences, Support Staff, PCPs, Specialists, Employees vs. contracted and Central Departments.
  • e. Stays current of industry coding, compliance, and HCC issues.
  • f. Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies.
• Contributes to team effort by accomplishing related results as needed.
• Other duties as assigned to meet the organization’s needs.

Experience:

Required:

Minimum 3+ years of coding in a medical group or health plan setting required;
Professional Coding experience required. Minimum 1 year experience with strategic planning in risk mitigation.

Work Hours:

Pacific Standard Time

Preferred:
Previous experience and use of Epic, Allscripts, EZCap a plus

Education:

Required:

High School Diploma or GED.

Training:
Preferred:
Certified Coder training courses

Specialized

Skills:

Required:

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;

Mathematical

Skills:

Ability to perform…