Medical coder Jobs in Fullerton, CA

Job Number6756Workplace Type : Hybrid RemoteRemote-US,California

By leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture, Alignment Health is revolutionizing health care for seniors! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

Overview of the role :

To effectively interface with provider partners, to successfully, monitor and implement HCC coding strategies. Audit all RAPS submissions to ensure accuracy in the data provided to CMS. Provide coding expertise as well as administrative oversight to ensure successful integration of AHC's HCC initiatives.

Responsibilities :

• Monitors coding & abstracting quality by conducting & / or coordinating ongoing audits to ensure coding quality & performance improvement standards are maintained, achieved & improved.
• Develop, implement, evaluate & improve IPA’s educational tools for their respective providers in order to accurately capture acute and chronic conditions.
• 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.
• Work with Risk Adjustment Management on any Data Validation and / or RADV coding audit to ensure completeness and coding accuracy of all submissions to CMS.
• Maintain a comprehensive tracking and management tool for assigned IPA’s within Alignments Healthcare provider network.
• Ensures compliance with all applicable federal, state &local regulations, as well as with institutional / organizational standards, practices, policies & procedures.
• Support the Risk Adjustment and STARs Management Team in scheduling / training activities. Maintain records of training.
• Work with Risk Adjustment and STARs Management on the monitoring of HCC Corrective Action Plans as needed.
• Suggest new Physician Group Risk Adjustment coding initiatives. Participate in SCITs / Education meetings as needed
• Coordinate 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
• Regularly update all Risk Adjustment materials for clinical and official guideline changes.
• Update all education materials based on CMS-HCC Model and ICD-10 annual changes
• Suggest, update, and enhance clinical educational materials to assist in training physicians and clinical staff on Risk Adjustment Healthcare Programs including CMSHCC Models, Clinician Chart Reviews, and Encounter Documentation.
• Suggest customizations of Risk Adjustment education and STARs education for various audiences; Support Staff, PCPs, Specialists, Employees vs. contracted and Central Departments
• Stay current of industry coding, compliance and HCC issues.
• Utilize, protect, and disclose Alignment Healthcare patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
• Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies.
• Contribute to team effort by accomplishing related results as needed.
• Assists with the all HEDIS medical Record reviews for HEDIS Quality Data abstractions

Required skills and experience :

Three-five years of coding in a medical group or health plan setting required; Professional Coding experience required.

Previous use of Epic, Allscripts, EZCap, Athena

Proficient user in MS office suite, MS access a plus

Certified Coder required, CCS, CCS-P, CPC, Certified Auditor a plus.

Experience with HEDIS abstractions a plus

Pay Range $54,199.00 - $81,100.00 annually

Please note : All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception / deferral).

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.