Medicare HCC Coding Analyst, CRC Certification

🕒 October 8

🇺🇸 United States – Remote

💵 $58.5k - $87.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 0%

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Alignment Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2013

⚕️ Healthcare Insurance

🛡️ Insurance

🏥 Healthcare

💰 $135M Series C on 2020-03

Healthcare Insurance • Insurance • Healthcare

Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members.

📋 Description

• Interface with provider partners to monitor and implement HCC coding strategies • Audit all RAPS submissions for accuracy of data provided to CMS • Conduct or coordinate ongoing coding and abstracting quality audits • Develop, implement, evaluate, and improve IPA educational tools for providers to accurately capture acute and chronic conditions • Track and report coding vendor audit progress to ensure coding accuracy and data quality submitted to CMS • Work with Risk Adjustment Management on Data Validation and RADV coding audits • Maintain tracking and management tools for assigned IPAs within the provider network • Track Risk Adjustment activities for assigned medical groups and ensure timely completion • Correlate activities, processes, and HCC results/metrics to evaluate outcomes • Ensure compliance with applicable federal, state, and local regulations and organizational policies • Support scheduling and training activities and maintain training records • Suggest physician group Risk Adjustment coding initiatives and participate in SCITs/education meetings • Coordinate Risk Adjustment audit activities for assigned groups and assist with CMS Data Validation activities • Update Risk Adjustment materials for clinical and official guideline changes • Update education materials based on CMS-HCC Model and ICD-9/ICD-10 annual changes • Enhance clinical educational materials for physicians and clinical staff on Risk Adjustment programs, clinician chart reviews, and encounter documentation • Customize Risk Adjustment education for different audiences • Stay current on industry coding, compliance, and HCC issues • Maintain professional and technical knowledge through workshops, publications, networks, and professional societies • Perform related duties as needed

🎯 Requirements

• Minimum 3+ years of coding in a medical group or health plan setting • Professional Coding experience • Minimum 1 year experience with strategic planning in risk mitigation • High School Diploma or GED • 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 constructive relationships with diverse members, management, employees and vendors • Ability to perform mathematical calculations and calculate simple statistics correctly • Ability to prioritize multiple tasks and use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolutions • Effective problem-solving, organizational and time management skills; ability to work in a fast-paced environment • Ability to comprehend and analyze statistical reports • Certified Coder required • HCC/Risk Adjustment experience • Experience with Athena EHR • Work Pacific Standard Time • Previous experience with Epic, Allscripts, or EZCap preferred • Certified Coder training courses preferred • Proficiency in MS Office Suite preferred; MS Access a plus • CCS, CCS-P, CPC, or Certified Auditor preferred