Remote Medicare HCC Coding Analyst | CRC Certification

Alignment Health; California; Remote; USD 59,000 - 88,000; Full time

Job summary

Alignment Health is seeking an HCC Coding Analyst to interface with provider partners, monitor coding quality, and support CMS submissions. You will audit RAPS, ensure accuracy, and provide coding expertise for Risk Adjustment initiatives.

The role emphasizes education, data validation, and collaboration with Risk Adjustment Management to improve accuracy and regulatory compliance.

Qualifications

• Minimum 3+ years of coding in a medical group or health plan setting.
• Experience with Risk Adjustment and HCC coding.
• Proficiency with CMS submission processes and data validation.
• Experience with Epic, Allscripts, EZCap a plus.
• Proficient with MS Office; MS Access a plus.

Responsibilities

• Monitor coding & abstracting quality through audits and improvement initiatives.
• Develop and update educational tools for providers to capture conditions accurately.
• Track audits of coding vendors and ensure data accuracy for CMS submissions.
• Collaborate with Risk Adjustment Management on data validation audits.
• Maintain tracking tools for assigned IPA groups within Alignment Health's network.

Skills

Communication skills

Leadership

Mathematical skills

Reasoning ability

Problem solving

Report analysis

Education

High School Diploma or GED

Tools

Epic

Allscripts

EZCap

Athena EHR

Job description

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.The Hierarchical Condition Categories (HCC) Coding Analyst will effectively interface with provider partners, to successfully, monitor and implement HCC coding strategies. Audit all RAPS submissions to ensure accuracy in the data provided to Centers for Medicare and Medicaid Services (CMS). Provide coding expertise as well as administrative oversight to ensure successful integration of AHC's HCC initiatives.

GENERAL DUTIES/RESPONSIBILITIES

1. Monitors coding & abstracting quality by conducting &/or coordinating ongoing audits to ensure coding quality & performance improvement standards are maintained, achieved & improved.
2. Develops, implements, evaluates & improves IPA’s educational tools for their respective providers in order to accurately capture acute and chronic conditions.
3. Tracks & reports progress of the audits performed on the coding vendors in order to assure the coding accuracy and quality of the data submitted to CMS.
4. Works with Risk Adjustment Management on any Data Validation and /or RADV coding audit to ensure completeness and coding accuracy of all submissions to CMS.
5. Maintains a comprehensive tracking and management tool for assigned IPA’s within Alignments Healthcare provider network.
6. Tracks all Risk Adjustment activities for assigned medical groups and ensure that all tasks are completed in a timely manner. Correlate activities, processes, and HCC results/ metrics to evaluate outcomes.
7. Ensures compliance with all applicable federal, state &local regulations, as well as with institutional/organizational standards, practices, policies & procedures.
8. Supports the Risk Adjustment Management Team in scheduling/training activities. Maintain records of training.
9. Suggests new Physician Group Risk Adjustment coding initiatives. Participate in SCITs/ Education meetings as needed
10. Coordinates 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
11. Educates and updates:
    • Regularly updates all Risk Adjustment materials for clinical and official guideline changes.
    • Updates all education materials based on CMS-HCC Model and ICD-9/ ICD-10 annual changes
    • Suggests, updates, and enhances 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.
    • Suggests customizations of Risk Adjustment education for various audiences, Support Staff, PCPs, Specialists, Employees vs. contracted and Central Departments
    • Stays current of industry coding, compliance, and HCC issues.
    • Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies.
12. Contributes to team effort by accomplishing related results as needed.
13. Other duties as assigned to meet the organization’s needs.

Job Requirements

Experience

• Required: Minimum 3+ years of coding in a medical group or health plan setting required; Professional Coding experience required. Minimum 1 year experience with strategic planning in risk mitigation.
• Work Hours: Pacific Standard Time
• Preferred: Previous experience and use of Epic, Allscripts, EZCap a plus

Education

• Required: High School Diploma or GED.

Training

• Preferred: Certified Coder training courses

Specialized Skills

Required

• Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
• Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;
• Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly
• Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.
• Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
• Report Analysis Skills: Comprehend and analyze statistical reports.

Preferred

Proficient user in MS office suite, MS access a plus

Licensure

• Required: Certified Coder required, HCC/Risk Adjustment experience, Experience with Athena EHR
• Preferred: CCS, CCS-P, CPC, Certified Auditor a plus.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

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.

Pay Range: $58,531.00 - $87,797.00

Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

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.