Astrana Health
Risk Adjustment Coding Specialist II (Central Georgia)
Astrana Health, Alhambra, California, us, 91802
Overview
We are currently seeking a highly motivated Risk Adjustment Coding Specialist II. This role will report to a Sr. Manager - Risk Adjustment and will conduct provider medical record audits, analysis of practice coding patterns, education and training regarding risk adjustment to ensure accurate CMS payment and improve quality of care. Requires travel to provider sites in surrounding areas. Location
1668 S. Garfield Ave. 2nd Floor, Alhambra, CA 91801 Compensation
$75,000 - $85,000 / year Department
Quality - Risk Adjustment What Youll Do
Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company Review medical record information on both a retroactive and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC) Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines Interacts with physicians regarding coding, billing, documentation policies, procedures, and conflicting/ambiguous or non-specific documentation Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes, stay informed about changes in Medicare, Medicaid, and private payer requirements Provide recommendations to management related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives Train, mentor and support new employees during the orientation process; function as a resource to existing staff for projects and daily work Provide peer-to-peer guidance through informal discussion and overread assignments; support coder training and orientation as requested by manager May assist or lead projects and/or handle higher work volume than Risk Adjustment Coding Specialist I Qualifications
Must possess and maintain AAPC or AHIMA certification - Certified Risk Adjustment Coder (CRC) & Certified Coding Specialist (CCS-P), CCS, CPC 3-5+ years of experience in risk adjustment coding and/or billing experience required Reliable transportation/Valid Driver License; travel up to 75% of work time, if applicable PC skills with Microsoft Word, Excel, and Outlook Excellent presentation, verbal and written communication skills, and ability to collaborate; ability to educate and train provider office staff Proficiency with healthcare coding software and Electronic Health Records (EHR) systems You're great for this role if
Strong billing knowledge and/or Certified Professional Biller (CPB) through APPC Knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage Strong PowerPoint and public speaking experience Strong Excel skills (pivot tables, VLOOKUP, etc.) Ability to work independently and collaborate in a team Experience with Monday.com Experience collaborating with, educating, and presenting to provider teams in a face-to-face setting Environmental Job Requirements and Working Conditions
Hybrid work structure; work both in provider offices and remotely. This position will require up to 75% travel to provider offices in the surrounding areas in Central Georgia; time not traveling is remote work. Hours: Monday through Friday, standard business hours. Total pay range for this role is $75,000 - $85,000 per year. Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.
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We are currently seeking a highly motivated Risk Adjustment Coding Specialist II. This role will report to a Sr. Manager - Risk Adjustment and will conduct provider medical record audits, analysis of practice coding patterns, education and training regarding risk adjustment to ensure accurate CMS payment and improve quality of care. Requires travel to provider sites in surrounding areas. Location
1668 S. Garfield Ave. 2nd Floor, Alhambra, CA 91801 Compensation
$75,000 - $85,000 / year Department
Quality - Risk Adjustment What Youll Do
Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company Review medical record information on both a retroactive and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC) Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines Interacts with physicians regarding coding, billing, documentation policies, procedures, and conflicting/ambiguous or non-specific documentation Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes, stay informed about changes in Medicare, Medicaid, and private payer requirements Provide recommendations to management related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives Train, mentor and support new employees during the orientation process; function as a resource to existing staff for projects and daily work Provide peer-to-peer guidance through informal discussion and overread assignments; support coder training and orientation as requested by manager May assist or lead projects and/or handle higher work volume than Risk Adjustment Coding Specialist I Qualifications
Must possess and maintain AAPC or AHIMA certification - Certified Risk Adjustment Coder (CRC) & Certified Coding Specialist (CCS-P), CCS, CPC 3-5+ years of experience in risk adjustment coding and/or billing experience required Reliable transportation/Valid Driver License; travel up to 75% of work time, if applicable PC skills with Microsoft Word, Excel, and Outlook Excellent presentation, verbal and written communication skills, and ability to collaborate; ability to educate and train provider office staff Proficiency with healthcare coding software and Electronic Health Records (EHR) systems You're great for this role if
Strong billing knowledge and/or Certified Professional Biller (CPB) through APPC Knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage Strong PowerPoint and public speaking experience Strong Excel skills (pivot tables, VLOOKUP, etc.) Ability to work independently and collaborate in a team Experience with Monday.com Experience collaborating with, educating, and presenting to provider teams in a face-to-face setting Environmental Job Requirements and Working Conditions
Hybrid work structure; work both in provider offices and remotely. This position will require up to 75% travel to provider offices in the surrounding areas in Central Georgia; time not traveling is remote work. Hours: Monday through Friday, standard business hours. Total pay range for this role is $75,000 - $85,000 per year. Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.
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