CMS HCC Coder Hybrid remote Orange, CA.

Alignment Health is breaking the mold in conventional health care committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we this fast-growing company you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters not only changing lives but saving them. Together.

GENERAL DUTIES/RESPONSIBILITIES
1. Monitors coding & abstracting quality by conducting &/or coordinating ongoing audits to ensure coding quality & performance improvement standards are maintained achieved & improved.
2. Develops implements evaluates & improves IPAs educational tools for their respective providers in order to accurately capture acute and chronic conditions.
3. 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.
4. Works with Risk Adjustment Management on any Data Validation and /or RADV coding audit to ensure completeness and coding accuracy of all submissions to CMS.
5. Maintains a comprehensive tracking and management tool for assigned IPAs within Alignments Healthcare provider network.
6. Tracks all Risk Adjustment activities for assigned medical groups and ensure that all tasks are completed in a timely manner. Correlate activities processes and HCC results/ metrics to evaluate outcomes.
7. Ensures compliance with all applicable federal state &local regulations as well as with institutional/organizational standards practices policies & procedures.
8. Supports the Risk Adjustment Management Team in scheduling/training activities. Maintain records of training.
9. Suggests new Physician Group Risk Adjustment coding initiatives. Participate in SCITs/ Education meetings as needed
10. Coordinates 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
11. Educates and updates:
a. Regularly updates all Risk Adjustment materials for clinical and official guideline changes.
b. Updates all education materials based on CMS-HCC Model and ICD-9/ ICD-10 annual changes
c. Suggests updates and enhances clinical educational materials to assist in training physicians and clinical staff on Risk Adjustment Healthcare Programs including CMS-HCC Models Clinician Chart Reviews and Encounter Documentation.
d. Suggests customizations of Risk Adjustment education for various audiences Support Staff PCPs Specialists Employees vs. contracted and Central Departments
e. Stays current of industry coding compliance and HCC issues.
f. Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies.
12. Contributes to team effort by accomplishing related results as needed.
13. Other duties as assigned to meet the organizations needs.

Job Requirements:

Experience:

Required: Minimum 3 years of coding in a medical group or health plan setting required; Professional Coding experience required. Minimum 1 year experience with strategic planning in risk mitigation.

Work Hours: Pacific Standard Time

Preferred: Previous experience and use of Epic Allscripts EZCap a plus

Education:

Required: High School Diploma or GED.

Training:

Preferred: Certified Coder training courses

Specialized Skills:

Required:

• 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 a constructive relationship with diverse members management employees and vendors;
• Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly
• Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems collect data establish facts draw valid conclusions and design implement and manage appropriate resolution.
• Problem-Solving Skills: Effective problem solving organizational and time management skills and ability to work in a fast-paced environment.
• Report Analysis Skills: Comprehend and analyze statistical reports.

Preferred: Proficient user in MS office suite MS access a plus

Licensure:

Required: Certified Coder required HCC/Risk Adjustment experience Experience with Athena EHR

Preferred: CCS CCS-P CPC Certified Auditor a plus.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

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 accommodations may be made to enable individuals with disabilities to perform the essential functions.

1 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.

2 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.

Pay range may be based on a number of factors including market location education responsibilities experience etc.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin disability age protected veteran status gender identity or sexual orientation.

*DISCLAIMER:Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal be advised that Alignment Health and its subsidiaries will never ask you for a credit card send you a check or ask you for any type of payment as part of consideration for employment with our you feel that you have been the victim of a scam such as this please report the incident to the Federal Trade Commission at If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Healths talent acquisition team please email.