[Hiring] MRA 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.
• 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, establishing personal networks, 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.
• Preferred: Bachelor’s degree in Business Administration, Health Care Management or in a related field.

Requirements

• Required: High School Diploma or GED. Completion of a Medical Coding training program.
• Required: Technical School or courses that are required to become a certified coder.
• Required: Certified Coder required, CCS, CCS-P, CPC, or CRC.

Specialized Skills

• 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 advanced problem-solving.
• Problem-Solving Skills: Effective problem solving, organizational and time management skills.
• Report Analysis Skills: Comprehend and analyze statistical reports.

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

• Regularly required to talk or hear, stand, walk, sit, use hands to handle or feel objects, tools, or controls; and reach with hands and arms.
• Frequently lifts and/or moves up to 10 pounds. Specific vision abilities required include close vision and the ability to adjust focus.

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.

Equal Opportunity Statement

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

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