[Hiring] Risk Adjustment Provider Engagement Lead @Alignment Health

Role Description

The Risk Adjustment Provider Engagement Lead is responsible for building relationships with our external physicians while conducting medical record reviews, monitoring, and analyzing coding patterns, and providing onsite education. Provide coding expertise as well as administrative oversight to improve the overall quality of the documentation; ensuring that it is to the highest level of specificity in accordance to the CMS guidelines.

• Validates provider documentation for accuracy by reviewing and analyzing samples of coding and claims extracts compared to actual medical records.
• Develops education materials to assist physicians in accurately assessing patients’ overall health status.
• Provides feedback to providers on performance improvement opportunities; tracks and prioritizes projects to improve coding and documentation outcomes.
• Maintains a comprehensive tracking and management tool for assigned physicians within Alignments Healthcare provider network.
• Identifies issues, determines impact to risk adjustment models, and reports results timely to ensure that physicians remain in compliance.
• Collect, analyze, and share MRA performance data through clear presentations and detailed reports, including outreach priorities, HCC gap data, and encounter status insights for use through Joint Working Groups (JWGs) with internal and external stakeholders.
• Collaborate with internal and external coding, analytics, and clinical teams to ensure accurate and complete diagnosis coding and HCC Gap Closures.
• Presents progress and results to leadership on a routine basis.
• Assists with CMS Risk Adjustment Data Validation activities to ensure our external physicians and Alignment Healthcare is prepared for and will pass an audit.
• Regularly updates all Risk Adjustment materials with clinical and/or official guideline changes.
• 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.
• Suggests customizations of Risk Adjustment education for various audiences; Support Staff, PCPs, Specialists, Employees vs. contracted and Central Departments.
• Stays current on industry coding, compliance and HCC issues.
• Utilizes, protects, and discloses Alignment Healthcare patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies.
• Local travel is required.

Qualifications

• Three-five years of coding in a medical group or health plan setting required; Professional Coding experience required.
• Experience with strategic planning in risk mitigation.
• Preferred: Proficiency in MS Office suite including Access.
• Previous use of Epic, Allscripts, EZCap a plus.

Requirements

• Bachelor’s degree in business administration, health care management or a related field or equivalent experience.
• Current driver’s license.
• Preferred: Nursing degree.
• Required: CPC, CPC-H, CCS, CCS-P, RHIT, RHIA, OR CPMA.

Benefits

• Pay Range: $70,823.00 - $106,234.00.
• Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.