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Alignment Health
Alignment Health
501 – 1.000 Angajați
Asigurare de sănătateAsigurăriAsistență medicală
Alignment Health este o companie de asigurări de sănătate axată pe îmbunătățirea îngrijirii pentru membrii Medicare, în special pentru vârstnici, persoane care trăiesc cu afecțiuni cronice și persoane fragile. Fondată în 2013, compania combină un model de îngrijire personalizat cu tehnologia și o echipă de îngrijire concierge disponibilă 24 de ore din 24, 7 zile din 7, pentru a coordona sprijinul împreună cu furnizori locali de încredere. Activitatea sa acoperă furnizarea de servicii medicale și asigurările, cu accent pe o îngrijire mai accesibilă, mai promptă și mai atentă la costuri pentru membrii săi. Alignment Health face angajări în cadrul unei organizații de sănătate aflate în creștere, care răspunde nevoilor comunităților Medicare.
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Locurile de muncă ale companiei

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.

USStatele Unite ale Americii
64.384 $ – 96.577 $ / an
RemoteNormă întreagăNivel mediuSeniorLimbă Obligatorie: englezăAuditor

Descriere

  • 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

Cerințe

  • 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

Beneficii

  • 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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