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Alignment Health
Alignment Health
501 – 1,000 Employees
HealthcareHealthcare InsuranceInsurance
Alignment Health is a healthcare insurance company focused on improving care for Medicare members, particularly seniors, people living with chronic conditions, and those who are frail. Founded in 2013, the company combines a personalized care model with technology and a 24/7 concierge care team to coordinate support with trusted local providers. Its work spans healthcare delivery and insurance, with a focus on making care more accessible, responsive, and cost-conscious for its members. Alignment Health hires across a growing healthcare organization serving the needs of Medicare communities.
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Medicare Risk Adjustment Coding Auditor (CRC) - United States Remote

Audit Medicare risk-adjustment coding and CMS data quality for Alignment Health while supporting accurate documentation, compliance, and care for seniors and chronically ill patients.

USUnited States
$64,384 – $96,577 / year
RemoteFull-timeMiddleSeniorEnglish RequiredAuditor

Description

  • Conduct quality assurance audits of the internal Coding Analyst team to validate coding and abstraction accuracy against the 95% HCC standard
  • Track and report the progress of quality audits conducted for coding vendors
  • Validate the accuracy and quality of data submitted to Alignment Health for CMS reporting
  • Partner with Risk Adjustment Management on MRA data validation and coding audits
  • Review reconciliation data, data-flow integrity, UAT results, high-cost or low-risk-score members, retrospective charts, and other risk-adjustment activities
  • Analyze audit findings and communicate results to the Manager
  • Use audit findings to support physician and clinical staff training, documentation improvements, and system or process enhancements
  • Handle patient PHI in accordance with HIPAA requirements for use, protection, and disclosure
  • Follow applicable regulations and organizational policies and procedures
  • Keep coding, compliance, and HCC knowledge current through ongoing professional and technical development
  • Complete other assigned responsibilities

Requirements

  • At least three years of Medicare risk-adjustment coding experience in a medical group or health plan
  • High school diploma or GED
  • Completion of a medical coding training program
  • Technical school training or coursework leading to coder certification
  • Required certification as a CCS, CCS-P, CPC, or CRC
  • Proficiency with Microsoft Office, including Excel, Word, and Outlook
  • Prior experience using Epic, Allscripts, and EZCap
  • Strong written and verbal communication skills
  • Capacity to lead, teach, and collaborate with colleagues
  • Ability to build and maintain productive relationships with diverse members, managers, employees, and vendors
  • Ability to perform mathematical calculations and accurately calculate basic statistics
  • Advanced problem-solving and reasoning ability
  • Ability to manage competing priorities in a fast-paced environment
  • Ability to interpret and analyze statistical reports
  • Ability to follow HIPAA requirements and applicable federal, state, and local regulations
  • Ability to maintain the continuing education units required for coding certifications

Benefits

  • Opportunities for professional growth and innovation
  • Continuing education and professional development through workshops, industry publications, professional networks, and professional societies
  • Coding-certification continuing education units
  • Reasonable accommodations for employees with disabilities
  • Equal employment opportunity

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