Medicare Risk Adjustment Coding Auditor, Certified Risk Adjustment Coder

🔥 3 minutes ago

🇺🇸 United States – Remote

💵 $64.4k - $96.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

👻 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

• Support regular quality assurance audits of the internal Coding Analyst team to validate coding and abstracting quality and maintain a 95% HCC accuracy standard • Track and report progress of quality assurance audits performed on coding vendors • Verify coding accuracy and quality of data submitted to Alignment Health for CMS submission • Work with Risk Adjustment Management on MRA data validation and coding audits • Review data for reconciliation, data-flow integrity, UAT testing, high-cost/low-risk-score members, retrospective chart reviews, and other risk-adjustment-related activities • Analyze and share audit results with the Manager • Support physician and clinical staff training, documentation improvement, and system/process improvement using audit results • Utilize, protect, and disclose patient PHI according to HIPAA standards • Ensure compliance with applicable regulations and organizational policies and procedures • Maintain professional and technical knowledge and stay current on coding, compliance, and HCC issues • Perform other duties as assigned

🎯 Requirements

• Minimum three years of Medicare Risk Adjustment coding in a medical group or health plan setting • High School Diploma or GED • Completion of a Medical Coding training program • Technical School or courses required to become a certified coder • Certified Coder required: CCS, CCS-P, CPC, or CRC • Proficient user of MS Office Suite – Excel, Word, Outlook • Previous use of Epic, Allscripts, and EZCap • Effective written and oral communication skills • Ability to provide leadership, teach, and collaborate with others • Ability to establish and maintain constructive relationships with diverse members, management, employees, and vendors • Ability to perform mathematical calculations and calculate simple statistics correctly • Advanced problem-solving and reasoning skills • Ability to prioritize multiple tasks and work in a fast-paced environment • Ability to comprehend and analyze statistical reports • Ability to comply with HIPAA and applicable federal, state, and local regulations • Ability to maintain relevant CEUs for individual coding certifications

🏖️ Benefits

• Ample room for growth and innovation • Continuing education and professional development through educational workshops, professional publications, personal networks, and professional societies • Continuing education units (CEUs) related to coding certifications • Reasonable accommodations for individuals with disabilities • Equal employment opportunity