Medicare Risk Adjustment Compliance Auditor, CPC, CCS, CCS-P Required

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $64.4k - $96.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

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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

• Conduct provider- and coder-level reviews and audits to ensure accurate risk adjustment data is submitted to CMS • Develop and maintain tracking tools for Risk Adjustment Compliance • Review and audit outcomes and findings and monitor corrective action plans • Monitor internal reporting for coding outliers • Stay current with CMS audit processes and participate in risk adjustment audits • Monitor coding prevalence reporting for coding outliers • Review IPA policies and procedures for program compliance • Monitor internal coding staff accuracy percentages • Monitor coding vendors’ accuracy percentages and data quality submitted to CMS • Work with Risk Adjustment Management on data validation and RADV coding audits • Ensure compliance with applicable federal, state, and local regulations and organizational standards, policies, and procedures • Monitor HCC Corrective Action Plans • Suggest customizations of Risk Adjustment education for support staff, providers, employees, contracted employees, and central departments • Use, protect, and disclose patient PHI according to HIPAA standards • Maintain professional and technical knowledge through educational workshops, professional publications, networks, and professional societies • Represent the department in RADV and other risk adjustment audits • Perform other duties as assigned

🎯 Requirements

• Minimum 3 years of professional coding experience in a medical group or health plan setting • Bachelor’s degree in business administration, health care management or a related field, or 4 years additional experience in lieu of education • Certified Coder required - CPC, CCS & CCS-P • Experience with strategic planning in risk mitigation • Proficient user in MS Office suite • 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 problem-solving and 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 • Must meet the physical demands of the role, including talking, hearing, standing, walking, sitting, using hands and fingers, reaching, and frequently lifting or moving up to 10 pounds • Specific vision abilities include close vision and the ability to adjust focus

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