Job description

Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.

By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. 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 community.

To 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 CMS. Provide coding expertise as well as administrative oversight to ensure successful integration of AHC's HCC initiatives.

General Duties/Responsibilities:
(May include but are not limited to)

• Monitors coding & abstracting quality by conducting &/or coordinating ongoing audits to ensure coding quality & performance improvement standards are maintained, achieved & improved.
• Develop, implement, evaluate & improve 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.
• Work with Risk Adjustment Management on any Data Validation and /or RADV coding audit to ensure completeness and coding accuracy of all submissions to CMS.
• Maintain a comprehensive tracking and management tool for assigned IPA’s within Alignments Healthcare provider network.
• Ensures compliance with all applicable federal, state &local regulations, as well as with institutional/organizational standards, practices, policies & procedures.
• Support the Risk Adjustment and STARs Management Team in scheduling/training activities. Maintain records of training.
• Work with Risk Adjustment and STARs Management on the monitoring of HCC Corrective Action Plans as needed.
• Suggest new Physician Group Risk Adjustment coding initiatives. Participate in SCITs/ Education meetings as needed
• Coordinate 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
• Regularly update all Risk Adjustment materials for clinical and official guideline changes.
• Update all education materials based on CMS-HCC Model and ICD-10 annual changes
• Suggest, update, and enhance clinical educational materials to assist in training physicians and clinical staff on Risk Adjustment Healthcare Programs including CMSHCC Models, Clinician Chart Reviews, and Encounter Documentation.
• Suggest customizations of Risk Adjustment education and STARs education for various audiences; Support Staff, PCPs, Specialists, Employees vs. contracted and Central Departments
• Stay current of industry coding, compliance and HCC issues.
• Utilize, protect, and disclose Alignment Healthcare patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
• Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies.
• Contribute to team effort by accomplishing related results as needed.
• Assists with the all HEDIS medical Record reviews for HEDIS Quality Data abstractions
• Other duties as assigned to meet the organization’s needs.

Minimum Requirements:

Minimum Experience:

• Three-five years of coding in a medical group or health plan setting required; Professional Coding experience required.
• Previous use of Epic, Allscripts, EZCap a plus
• Proficient user in MS office suite, MS access a plus

Education/Licensure:

• Certified Coder required, CCS, CCS-P, CPC, Certified Auditor a plus.

Other:

• Experience with HEDIS abstractions a plus

Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable
may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
• The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance
• Work from home

Schedule:

• 8 hour shift
• Monday to Friday

Ability to commute/relocate:

• Orange, CA 92868: Reliably commute or planning to relocate before starting work (Required)

Application Question(s):

• What is your pay requirement?

License/Certification:

• Certified Professional Coder (Preferred)
• Certified Coding Specialist (Preferred)

Work Location: Hybrid remote in Orange, CA 92868

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