Alignment Health is a healthcare organization serving seniors and chronically ill patients. We're hiring a Medicare HCC Coding Analyst to work remotely from anywhere in the U.S.
What you'll do:
- Review and audit all RAPS submissions to ensure coding accuracy before data goes to the Centers for Medicare and Medicaid Services (CMS)
- Monitor coding quality by conducting and coordinating audits to maintain performance improvement standards
- Develop and implement educational tools for provider partners to accurately capture acute and chronic conditions
- Track and report audit progress on coding vendors to verify data accuracy
- Work with the Risk Adjustment Management team on Data Validation and RADV coding audits
- Maintain tracking systems for assigned IPAs within the provider network
- Monitor risk adjustment activities for assigned medical groups and ensure timely task completion
- Coordinate audit activities related to assigned groups and assist with CMS Data Validation
- Create and update risk adjustment educational materials based on CMS-HCC Model and ICD coding changes
- Educate physicians, clinical staff, and various audiences on risk adjustment programs and coding requirements
- Stay current on industry coding, compliance, and HCC issues
- Ensure compliance with all applicable federal, state, and local regulations
Requirements:
- High school diploma or GED
- Minimum 3 years of coding experience in a medical group or health plan setting
- Minimum 1 year of strategic planning experience in risk mitigation
- Certified Coder credential required
- HCC/Risk Adjustment experience required
- Experience with Athena EHR required
- Strong written and oral communication skills
- Ability to prioritize multiple tasks and problem-solve in a fast-paced environment
- Mathematical and statistical analysis skills
- Work hours in Pacific Standard Time
Preferred qualifications:
- CCS, CCS-P, CPC, or Certified Auditor certifications
- Experience with Epic, Allscripts, or EZCap
- Certified Coder training courses
- Proficiency in MS Office suite; MS Access a plus