Risk Adjustment Provider Engagement Lead

Job Number: 1193

Workplace Type:

Position Title: Risk Adjustment Provider Engagement Lead

External Description:

Position Summary:
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.

 

General Duties/Responsibilities:

• Validate provider documentation for accuracy by reviewing and analyzing samples of coding and claims extracts compared to actual medical records.
• Track and report progress of the chart reviews performed on the external physicians to assure the coding accuracy and quality of the data submitted to CMS is accurate to the highest level of specificity.
• Develop 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.
• Maintain a comprehensive tracking and management tool for assigned physicians within Alignments Healthcare provider network.
• Identify issues, determine impact to risk adjustment models, and report results timely to ensure that physicians remain in compliance.
• Conduct onsite provider education and training regarding risk adjustment to help ensure and increase the accuracy of the member’s health status.
• Present progress and results to leadership on a routine basis.
• Assist with CMS Risk Adjustment Data Validation activities to ensure our external physicians and Alignment Healthcare is prepared for and will pass an audit.
• Regularly update all Risk Adjustment materials with clinical and/or official guideline changes.
• Suggest, update, and enhance 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.
• Suggest customizations of Risk Adjustment 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.
• Other duties as assigned to meet the organization’s needs.

 

Supervisory Responsibilities:

N/A

Minimum Requirements:

 

1. Minimum Experience:
   1. Three-five years of coding in a medical group or health plan setting required; Professional Coding experience required.
   2. Previous use of Epic, Allscripts, EZCap a plus
   3. Proficient user in MS office suite, MS access a plus
   4. Local travel is required
2. Education/Licensure:
   1. Bachelor’s degree in Business Administration, health Care Management or in a related field or equivalent experience preferred.
   2. A nursing degree is preferred.
   3. Licenses/Certifications: CPC, CPC-H, CCS, CCS-P, RHIT, RHIA, OR CPMA required.

1. Other:
   1. Experience with strategic planning in risk mitigation.

 

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
 
While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
 
The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

City: San Jose

State: California

Location City: San Jose

Location State: California

Community / Marketing Title: Risk Adjustment Provider Engagement Lead

Company Profile:

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.

EEO Employer Verbiage:

 

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.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].