Junior Quality Improvement Coder — HEDIS & RAF Focus

DaMar Staffing; Orange (CA); On-site; USD 48,000 - 62,000; Full time

Benefits offered by this job

401(k)

Dental Insurance

Health Insurance

Life Insurance

Vision Insurance

Paid Time Off

Free catered lunches

Job summary

Astiva Health, Inc., located in Orange, CA is seeking a Junior Quality Improvement Coder to support departmental QI initiatives and collaborate with network providers and IPA's to improve the quality of care through RAF, HEDIS, CMS Star Ratings and related health plan reporting.

The role involves analyzing data from contracted IPA providers to review HEDIS and RAF, conducting internal reviews of documentation and billing, identifying coding risks, and preparing summary reports.

Qualifications

• 0 - 1 year of prior experience as a coder in a quality improvement role within a health plan, IPA or medical group.
• Certified Coding certificate required.
• Strong understanding of coding principals including HEDIS, Medicare Star ratings and Risk Adjustment.
• Strong understanding of the principals of HIPAA and able to maintain confidentiality.

Responsibilities

• Analyze data from contracted IPA network providers to evaluate HEDIS and Risk Adjustment Factor.
• Conduct internal reviews of documentation and billing on a timely basis.
• Identify coding and billing risk areas, conduct focused reviews.
• Collaborate with providers to ensure accurate documentation and coding for HEDIS and RAF reporting.
• Prepare summary reporting of the coding review results as requested.
• Participate in data collection and analysis discussions for HEDIS gaps in care.

Skills

Coding knowledge

HEDIS & Star Ratings

Risk Adjustment

HIPAA

Job description

Astiva Health, Inc., located in Orange, CA is seeking a Junior Quality Improvement Coder to support departmental QI initiatives and collaborate with network providers and IPA's to improve the quality of care through RAF, HEDIS, CMS Star Ratings and related health plan reporting.

The role involves analyzing data from contracted IPA providers to review HEDIS and RAF, conducting internal reviews of documentation and billing, identifying coding risks, and preparing summary reports.