MRA Coding Auditor
MRA Coding Auditor
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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 fastgrowing 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 MRA Coding Auditor supports departmental Quality Assessment audits of internal Coding Analyst team and vendors to ensure accurate and complete data is submitted to CMS. Assists in Risk Adjustment related data audits (RAF prevalence clinical documentation improvement P360 process) audits to identify areas of opportunity for improvement (training data integrity chart reviews).GENERAL DUTIES/RESPONSIBILITIES:
1. Supports regular quality assurance (QA) audits of internal Coding Analyst Team to validate and confirm coding & abstracting quality 95 HCC accuracy). These ongoing audits ensure coding quality & performance improvement standards are maintained achieved & improved per department policies and procedures.
2. Tracks and reports progress of QA audits performed on the coding vendors to verify the coding accuracy and quality of the data submitted to AHP is accurate for submission to CMS.
3. Works with Risk Adjustment Management on any MRA data validation / coding audit to ensure completeness and coding accuracy of all submissions to CMS. This work may encompass reviews of data for reconciliation data flow integrity UAT testing high cost / low risk score members retrospective chart reviews or other risk adjustment related data review as directed by Manager.
4. Analyzes and shares audit results with Manager. This information may be used for training physicians and clinical staff documentation improvement and system / process improvement.
5. Utilizes protects and discloses Alignment Healthcare patients protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
6. Ensures compliance with all applicable federal state &local regulations as well as with institutional/organizational standards practices policies & procedures.
7. Maintains professional / technical knowledge by attending appropriate educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies. Stay current of industry coding compliance and HCC issues. Required to maintain relevant continuing education units (CEUs) in relation to individual coding certifications.
8. Other duties as assigned to meet the organizations needs.
Job Requirements:
Experience:
Required: Minimum three years of Medicare Risk Adjustment coding in a medical group or health plan setting required
Preferred:
Education:
Required: High School Diploma or GED. Completion of a Medical Coding training program.
Preferred: Bachelors degree in Business Administration health Care Management or in a related field
Training:
Required: Technical School or courses that are required to become a certified coder.
Specialized Skills:
Required:
- Knowledge of
- Proficient user in MS office suite Excel Word Outlook
- Previous use of Epic Allscripts EZCap
- 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 problemsolving; ability to use advanced reasoning to define problems collect data establish facts draw valid conclusions and design implement and manage appropriate resolution.
- ProblemSolving Skills: Effective problem solving organizational and time management skills and ability to work in a fastpaced environment.
- Report Analysis Skills: Comprehend and analyze statistical reports.
Licensure:
Required: Certified Coder required CCS CCSP CPC or CRC
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: $64384.00 $96577.00Alignment 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.
*DISCLAIMER:Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employmentrelated offers in exchange for money or other sensitive personal be advised that Alignment Health and its subsidiaries will never ask you for a credit card send you a check or ask you for any type of payment as part of consideration for employment with our you feel that you have been the victim of a scam such as this please report the incident to the Federal Trade Commission at If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Healths talent acquisition team please email.
Employment Type
Full-Time
