HCC Coder (Temporary)

Job Number: 1485

Workplace Type:

Position Title: HCC Coding Analyst

External Description:

Alignment Healthcare is seeking a Hierarchical Condition Category (HCC) coder for a short-term temporary assignment to interface with provider partners and monitor and implement HCC coding strategies. As the HCC coder, you will be responsible for auditing all Risk Adjustment Payment System (RAPS) submissions to ensure accuracy in the data provided to Centers for Medicare and Medicaid Services (CMS), provide coding expertise, and administrative oversight to ensure successful integration of Alignment HCC initiatives.

General Duties / Responsibilities:
(May include but are not limited to)

• Monitor coding and abstracting quality by conducting and / or coordinating ongoing audits to ensure coding quality and performance improvement standards are maintained, achieved, and  improved.
• Develop, implement, evaluate, and improve IPA’s educational tools for their respective providers in order to accurately capture acute and chronic conditions.
• Track and report progress of the audits performed on the coding vendors in order to assure the coding accuracy and quality of the data submitted to CMS.
• Collaborate with risk adjustment management on any data validation and / or Risk Adjust Data Validation (RADV) coding audit to ensure completeness and coding accuracy of all submissions to CMS.
• Maintain comprehensive tracking and management tool for assigned IPA’s within the Alignment Healthcare provider network.
• Ensure compliance with all applicable federal, state, and local regulations, as well as with institutional and organizational standards, practices, policies and procedures.
• Support the risk adjustment and STARs management team in scheduling and maintaining records of training activities.
• Partner with risk adjustment and STARs management to monitor 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 CMS HCC models, clinician chart reviews, and encounter documentation.
• Suggest customization of risk adjustment education and STARs education for various audiences (including but not limited to) 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 patient 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 all HEDIS medical record reviews for HEDIS quality data abstractions.
• Other duties as assigned to meet the organization’s needs.

Minimum Requirements:

Minimum Experience:

• Three+ years' of coding in a medical group or health plan setting required
• Professional coding experience required
• Previous use of Epic, Allscripts, EZCap a plus
• Proficient user in MS office suite, MS access a plus

Education/Licensure:

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

Other:

• Experience with HEDIS abstractions a plus

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
 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.

Please note:

• Assignment length:  5 weeks

City: Orange

State: California

Location City: Orange

Location State: California

Community / Marketing Title: HCC Coder (Temporary)

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].