MRA Coding Auditor - Remote

About the role

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. This role also assists in Risk Adjustment related data audits to identify areas of opportunity for improvement.

Responsibilities

• Supports regular quality assurance (QA) audits of internal Coding Analyst Team to validate and confirm coding & abstracting quality (95% HCC accuracy).
• 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.
• Works with Risk Adjustment Management on any MRA data validation / coding audit to ensure completeness and coding accuracy of all submissions to CMS.
• Analyzes and shares audit results with Manager. This information may be used for training physicians and clinical staff, documentation improvement, and system / process improvement.
• Utilizes, protects, and discloses Alignment Healthcare patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
• Maintains professional / technical knowledge by attending appropriate educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies.
• Stays current of industry coding, compliance, and HCC issues.

Requirements

• Minimum three years of Medicare Risk Adjustment coding in a medical group or health plan setting required.
• High School Diploma or GED. Completion of a Medical Coding training program preferred.
• Technical School or courses that are required to become a certified coder preferred.
• 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 problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.
• Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
• Report Analysis Skills: Comprehend and analyze statistical reports.

Qualifications

• Knowledgeable in relevant coding certifications (CCS, CCS-P, CPC, CRC).
• Experience in a medical group or health plan setting with Medicare Risk Adjustment coding.
• Strong analytical and problem-solving skills.
• Excellent communication and interpersonal skills.
• Ability to work independently and as part of a team.

Skills

• Coding Audit
• Risk Adjustment
• Data Validation
• Quality Assurance
• Healthcare Compliance

Benefits

Alignment Health offers a comprehensive benefits package including health insurance, dental, vision, retirement plans, paid time off, and more.

Pay

$64,384.00 - $96,577.00

Schedule

This is a remote position.