Risk Adjustment Specialist

California, CA - USA

Yearly Salary: $ 80000 - 90000

Posted on: 10 hours ago

Vacancies: 1 Vacancy

Job Summary

Astrana Health is seeking an experienced Risk Adjustment QA Specialist to join our this role you will ensure accurate and compliant documentation through chart audits provider education and ongoing monitoring. You will deliver actionable feedback to HCC coding auditors and providers within the Astrana Health network helping to improve documentation practices and meet regulatory standards.

What Youll Do

Abstract pertinent information from assigned medical records using ICD-9-CM ICD-10-CM CPT and/or HCPCS codes.
Provide detailed comments/feedback on physician performance based on encounter audits.
Document detailed chart audit findings including all documentation errors; medical record errors; diagnosis errors as well as missed HCC opportunities.
Identify documentation training and HCC coding review training opportunities.
Encounter audits will be the primary monitoring tool used to identify operational and regulatory issues related to coding documentation and compliance requirements and to ensure complete and accurate data capture in compliance with Federal and State requirements.
Monitor corrective actions for audit review findings.
Serves as a local resource in meeting internal and external regulatory requirements (e.g. Centers for Medicare & Medicaid Service (CMS) National Committee for Quality Assurance (NCQA)).
Actively participate with local CMS (Center for Medicare/Medical Services) team to ensure local objectives are met and regional CMS compliance activities are supported.
Works with medical center leadership to provide confidential audits and feedback on an as needed basis.
Assist in the identification of operational processes that hinder encounter data capture.
Prepare and/or perform auditing analysis and/or special projects as assigned.
Provide feedback on noncompliance issues detected through auditing.
Provide audit support to the HCC Risk Adjustment program specifically the yearly Wellness Visit Program.
Submit bi-weekly and monthly audit finding reports.

Qualifications

High School Diploma or equivalent. Bachelors degree preferred.
5 years of experience in a healthcare setting related to HCC Risk Adjustment and chart auditing
Current AAPC or AHIMA certification (CCS CCS-P CPC CPC-H CPC-P RHIT or RHIA)
Strong understanding of CMS Risk Adjustment guidelines ICD coding and compliance requirements
Excellent written and verbal communication skills with the ability to educate providers
Strong analytical and problem-solving skills
Ability to work independently and manage multiple priorities in a fast-paced environment
Proficiency with Microsoft Word Excel and Outlook

Environmental Job Requirements and Working Conditions

This is a hybrid role within the United States. The home office is aligned with your department at 600 City Parkway West 10th Floor Orange CA 92868.
Work hours: Monday through Friday standard business hours
Work schedule: You will be required to work onsite about two days per week at one of our corporate offices in Orange Monterey Park or Alhambra. You will be traveling to provider offices in Orange County approximately 10% of the time.
The national target pay range for this role is: $80000 - $90000. Actual compensation will be determined based on geographic location (current or future) experience and other job-related factors.

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on 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 applicable legally protected characteristics. All employment is decided based on qualifications merit and business need. If you require assistance in applying for open positions due to a disability please email us at to request an accommodation.

Additional Information:

The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

Required Experience:

What Youll Do

Abstract pertinent information from assigned medical records using ICD-9-CM ICD-10-CM CPT and/or HCPCS codes.
Provide detailed comments/feedback on physician performance based on encounter audits.
Document detailed chart audit findings including all documentation errors; medical record errors; diagnosis errors as well as missed HCC opportunities.
Identify documentation training and HCC coding review training opportunities.
Encounter audits will be the primary monitoring tool used to identify operational and regulatory issues related to coding documentation and compliance requirements and to ensure complete and accurate data capture in compliance with Federal and State requirements.
Monitor corrective actions for audit review findings.
Serves as a local resource in meeting internal and external regulatory requirements (e.g. Centers for Medicare & Medicaid Service (CMS) National Committee for Quality Assurance (NCQA)).
Actively participate with local CMS (Center for Medicare/Medical Services) team to ensure local objectives are met and regional CMS compliance activities are supported.
Works with medical center leadership to provide confidential audits and feedback on an as needed basis.
Assist in the identification of operational processes that hinder encounter data capture.
Prepare and/or perform auditing analysis and/or special projects as assigned.
Provide feedback on noncompliance issues detected through auditing.
Provide audit support to the HCC Risk Adjustment program specifically the yearly Wellness Visit Program.
Submit bi-weekly and monthly audit finding reports.

Qualifications

High School Diploma or equivalent. Bachelors degree preferred.
5 years of experience in a healthcare setting related to HCC Risk Adjustment and chart auditing
Current AAPC or AHIMA certification (CCS CCS-P CPC CPC-H CPC-P RHIT or RHIA)
Strong understanding of CMS Risk Adjustment guidelines ICD coding and compliance requirements
Excellent written and verbal communication skills with the ability to educate providers
Strong analytical and problem-solving skills
Ability to work independently and manage multiple priorities in a fast-paced environment
Proficiency with Microsoft Word Excel and Outlook

Environmental Job Requirements and Working Conditions

This is a hybrid role within the United States. The home office is aligned with your department at 600 City Parkway West 10th Floor Orange CA 92868.
Work hours: Monday through Friday standard business hours
Work schedule: You will be required to work onsite about two days per week at one of our corporate offices in Orange Monterey Park or Alhambra. You will be traveling to provider offices in Orange County approximately 10% of the time.
The national target pay range for this role is: $80000 - $90000. Actual compensation will be determined based on geographic location (current or future) experience and other job-related factors.

Additional Information:

Required Experience: