Risk Adjustment QA Specialist

Description

same as prior

What You'll Do

• Abstract pertinent information from assigned medical records using ICD-9-CM, ICD-10-CM, CPT and / or HCPCS codes.
• Provide detailed comments / feedback on physician performance based on encounter audits.
• Document detailed chart audit findings including all documentation errors; medical record errors; diagnosis errors as well as missed HCC opportunities.
• Identify documentation training and HCC coding review training opportunities.
• Encounter audits will be the primary monitoring tool used to identify operational and regulatory issues related to coding, documentation, and compliance requirements and to ensure complete and accurate data capture in compliance with Federal and State requirements.
• Monitor corrective actions for audit review findings.
• Serves as a local resource in meeting internal and external regulatory requirements (e.g., Centers for Medicare & Medicaid Service (CMS), National Committee for Quality Assurance (NCQA)).
• Actively participate with local CMS (Center for Medicare / Medical Services) team to ensure local objectives are met and regional CMS compliance activities are supported.
• Works with medical center leadership to provide confidential audits and feedback on an "as needed" basis.
• Assist in the identification of operational processes that hinder encounter data capture.
• Prepare and / or perform auditing analysis and / or special projects as assigned.
• Provide feedback on noncompliance issues detected through auditing.
• Provide audit support to the HCC Risk Adjustment program specifically the yearly Wellness Visit Program.
• Submit bi-weekly and monthly audit finding reports.

Qualifications

Environmental Job Requirements and Working Conditions

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.

Additional Information :

The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

Astrana Health (NASDAQ : ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.

Our platform currently empowers over 20,000 physicians to provide care for over 1.7 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.