[Hiring] Medicare Risk Adjustment Coding Auditor @Alignment Health

Role Description

The MRA Coding Auditor supports departmental Quality Assessment audits of internal Coding Analyst team and vendors to ensure accurate and complete data is submitted to CMS. Assists in Risk Adjustment related data audits (RAF, prevalence, clinical documentation improvement, P360, process) audits to identify areas of opportunity for improvement (training, data integrity, chart reviews).

• Supports regular quality assurance (QA) audits of internal Coding Analyst Team to validate and confirm coding & abstracting quality (95% HCC accuracy).
• Tracks and reports progress of QA audits performed on the coding vendors to verify the coding accuracy and quality of the data submitted to AHP is accurate for submission to CMS.
• Works with Risk Adjustment Management on any MRA data validation / coding audit to ensure completeness and coding accuracy of all submissions to CMS.
• Analyzes and shares audit results with Manager for training physicians and clinical staff, documentation improvement, and system/process improvement.
• Utilizes, protects, and discloses Alignment Healthcare patients’ protected health information (PHI) in accordance with HIPAA standards.
• Ensures compliance with all applicable federal, state & local regulations, as well as with institutional/organizational standards, practices, policies & procedures.
• Maintains professional/technical knowledge by attending educational workshops, reviewing professional publications, and participating in professional societies.
• Other duties as assigned to meet the organization’s needs.

Qualifications

• Required: Minimum three years of Medicare Risk Adjustment coding in a medical group or health plan setting required.
• Required: High School Diploma or GED. Completion of a Medical Coding training program.
• Preferred: Bachelor’s degree in Business Administration, Health Care Management or in a related field.
• Required: Technical School or courses that are required to become a certified coder.
• Required: Certified Coder required, CCS, CCS-P, CPC, or CRC.

Requirements

• Knowledge of coding standards and practices.
• Proficient user in MS Office Suite – Excel, Word, Outlook.
• Previous use of Epic, Allscripts, EZCap.
• Ability to communicate positively, professionally, and effectively with others.
• Effective written and oral communication skills.
• Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly.
• Reasoning Skills: Ability to prioritize multiple tasks and use advanced reasoning to define problems.
• Problem-Solving Skills: Effective problem solving, organizational and time management skills.
• Report Analysis Skills: Comprehend and analyze statistical reports.

Benefits

• Remote position.
• Pay Range: $64,384.00 - $96,577.00.
• Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Company Description

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 serve. In 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.