HCC Coding Analyst

Location: Orange, California US

Notice

This position is no longer open.

Job Number: 1197

Workplace Type:

Position Title: HCC Coding Analyst

External Description:

Effectively interface with provider partners and management to successfully support Quality and Risk Adjustment initiatives.  Participate in various concurrent and retrospective programs, including chart audits, to ensure the accuracy of data provided to CMS.  Utilize academic knowledge and professional experience in coding to ensure the successful integration of AHP initiatives in multiple markets.    

General Duties/Responsibilities:

Build positive, consultative relationships with AHC provider partners in order to educate and improve clinical documentation and appropriately capture their patients' health status.

· Participate in concurrent medical record audits with the ability to assess and interpret whether the ICD-10 and/or CPT codes assigned were properly selected based upon the review of the services rendered, clinical documentation and application of coding guidelines so performance improvement standards are achieved, maintained and improved 
· Participate in ongoing retrospective chart audits of provider partners and vendors to verify and ensure the accuracy, completeness and specificity in the data provided to CMS
· Identify potential suspects through clinical documentation where a diagnosis is clinically indicated but not documented and discuss findings with providers for validation and confirmation
· Ability to rely on independent judgement to field questions/concerns and provide solutions that are compliant with all federal, state and local guidelines and regulations
· Provide feedback and present solutions regarding trends and/or patterns noticed in provider documentation and coding
· Responsible for maintaining current knowledge of ICD-10 coding guidelines
· Reports to Coding Quality Supervisor/Coding Quality Manager 
· Utilize multiple electronic data systems and resources to access information for further studies, research and analysis
· Review bulletins, newsletters, periodicals and attend educational workshops to stay current with issues and changes in the regulations governing medical record documentation and coding. 
· Complete other related tasks as assigned to meet the organizational needs/goals.

Minimum Requirements:

1. Minimum Experience:

  • a. Three to five years coding in a medical group or health plan setting required; 
  • b. Professional Coding experience required
  • c. Previous use of Epic, Allscripts, EZCap a plus

2. Education/Licensure:

  • a. Bachelor's degree in Business Administration, Health Care Management or related field or equivalent experience
  • b. Certified Coder required, CCS, CCS-P, CPC, Certified Auditor a plus

3. Other:

  • a. Reasoning Skills: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists
  • b. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form
  • c. Strong organization skills
  • a. Good analytical skills
  • b. Good interpersonal skills
  • c. Strong communication skills
  • d. Ability to effectively interface with staff, clinicians and management
  • e. Excellent communication skills with the ability to present complex materials to a diverse audience
  • f. Strong understanding of the principal guidelines governing CMS healthcare reimbursement including ICD-9/ICD-10 and CPT coding

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.

1. 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.
2. 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: Orange

State: California

Location City: Orange

Location State: California

Community / Marketing Title: HCC Coding Analyst

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].