Coding Analyst

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Alignment Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2013

⚕️ Healthcare Insurance

💰 $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

• Execute Accurate HCC Coding from Member Medical Records. • Review prospective and retrospective member medical records and assign accurate, compliant HCC codes using ICD-10-CM coding guidelines to support CMS Risk Adjustment submissions. • Conduct Structured Provider Coding Audits. • Perform structured audits of provider documentation and coding practices for assigned physician groups and clinical staff — identifying patterns of under-documentation, missed conditions, and coding inaccuracies, and delivering specific, actionable feedback that drives measurable and sustained improvement. • Deliver Provider-Facing Education and Training. • Develop and deliver targeted education on coding standards, CMS Risk Adjustment requirements, and clinical documentation best practices — tailoring content to the needs of PCPs, specialists, and clinical support staff across assigned CDO provider groups. • Identify and Close Provider-Level Documentation Gaps. • Flag unsupported diagnoses, incomplete clinical documentation, and missing eligible conditions — communicating findings directly to providers and care teams to close risk capture gaps at the source and reinforce documentation standards. • Ensure Compliance with CMS Coding Guidelines. • Apply current CMS Risk Adjustment coding rules, Official Guidelines for Coding and Reporting, and organizational policies to all coding and provider education activities — minimizing audit risk and ensuring submission integrity. • Meet Productivity and Quality Standards. • Achieve daily coding productivity targets and maintain quality scores at or above established benchmarks, contributing directly to the CDO's RAF accuracy and performance goals. • Maintain Current Knowledge of Coding and Regulatory Updates. • Stay current on ICD-10-CM updates, CMS Risk Adjustment model changes, and HCC coding guidance — applying changes promptly to all coding work and updating provider education materials accordingly. • Support Data Integrity and Accurate Reporting. • Ensure all coded data is entered accurately into applicable systems to support downstream risk adjustment reporting, encounter data submissions, and performance analytics used by CDO leadership

🎯 Requirements

• Minimum 2 years of experience in medical coding, with direct experience in Risk Adjustment or HCC coding in a Medicare Advantage, managed care, or health plan environment • Demonstrated experience with prospective and/or retrospective chart review coding • Working knowledge of ICD-10-CM coding systems and CMS Risk Adjustment methodology • Experience using electronic health record (EHR) systems and coding platforms • Formal training in ICD-10-CM coding and CMS Risk Adjustment methodology, through an accredited coding program or demonstrated equivalent experience • CPC (Certified Professional Coder) — AAPC; OR CCS (Certified Coding Specialist) — AHIMA; OR RHIT (Registered Health Information Technician) — AHIMA

🏖️ Benefits

• Health insurance • Retirement plans • Paid time off • Flexible work arrangements • Professional development opportunities