Risk Adjustment Provider Engagement Lead (Finance)

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 fast-growing 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 Risk Adjustment Provider Engagement Lead is responsible for building relationships with our external physicians while conducting medical record reviews, monitoring, and analyzing coding patterns, and providing onsite education. Provide coding expertise as well as administrative oversight to improve the overall quality of the documentation; ensuring that it is to the highest level of specificity in accordance to the CMS guidelines.

Job Duties and Responsibilities:

• Validates provider documentation for accuracy by reviewing and analyzing samples of coding and claims extracts compared to actual medical records.
• Develops education materials to assist physicians in accurately assessing patients' overall health status.
• Provides feedback to providers on performance improvement opportunities; tracks and prioritizes projects to improve coding and documentation outcomes.
• Maintains a comprehensive tracking and management tool for assigned physicians within Alignments Healthcare provider network.
• Identifies issues, determines impact to risk adjustment models, and reports results timely to ensure that physicians remain in compliance.
• Collect, analyze, and share MRA performance data through clear presentations and detailed reports, including outreach priorities, HCC gap data, and encounter status insights for use through Joint Working Groups (JWGs) with internal and external stakeholders.
• Collaborate with internal and external coding, analytics, and clinical teams to ensure accurate and complete diagnosis coding and HCC Gap Closures.
• Presents progress and results to leadership on a routine basis.
• Assists with CMS Risk Adjustment Data Validation activities to ensure our external physicians and Alignment Healthcare is prepared for and will pass an audit.
• Regularly updates all Risk Adjustment materials with clinical and/or official guideline changes.
• Suggests, updates, and enhances clinical educational materials to assist in training physicians and clinical staff on Risk Adjustment Healthcare Programs including CMS-HCC Models, Clinician Chart Reviews, and Encounter Documentation.
• Suggests customizations of Risk Adjustment education for various audiences; Support Staff, PCPs, Specialists, Employees vs. contracted and Central Departments
• Stays current on industry coding, compliance and HCC issues.
• 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 and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies.
• Local travel is required

Job Requirements:

Experience:

Required:

• Three-five years of coding in a medical group or health plan setting required; Professional Coding experience required.
• Experience with strategic planning in risk mitigation.

Preferred:

• Proficiency in MS Officer suite including Access
• Previous use of Epic, Allscripts, EZCap a plus

Education/Licensure:

Required:

• Bachelor's degree in business administration, health care management or a related field or equivalent experience
• Current driver's license

Preferred: Nursing degree

Licensure/Certification:

Required: CPC, CPC-H, CCS, CCS-P, RHIT, RHIA, OR CPMA

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.

• 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.
• 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: $65,865.00 - $98,798.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Alignment 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 employment-related offers in exchange for money or other sensitive personal information. Please 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 company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/ . If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please email careers@ahcusa.com .