Senior Coding Analyst, Risk Adjustment

About Our Company

At Altais, we're looking for bold and curious innovators who share our passion for enabling better health care experiences and revolutionizing the healthcare system for physicians, patients, and the clinical community. At Altais, we're building breakthrough clinical support tools, technology, and services to let doctors do what they do best: care for people. We invite you to join our growing passionate team as we change the game for the future of healthcare and enable the experience that people need and deserve. Altais family of companies include: Brown & Toland Physicians, Family Care Specialists and Altais Medical Groups.

About Your Team

Are you looking to work with a high performing, fast growing and dynamic Health and Innovations team? We are 4,000+ physicians, working in over 40 cities throughout California, caring for more than 500,000 patients. If you are passionate about reshaping healthcare and want to work for a mission driven organization where new ideas and innovation are valued, then we would like to meet you.

About Your Work

The Senior Coding Analyst will divide their time coding medical records for the purpose of HCC coding, including our annual health assessments, and working with our physicians on clinical documentation improvement. The Senior Coding Analyst, Risk Adjustment provides support and coding expertise to all programs that support risk adjustment and data validation efforts for our Medicare Advantage line of business, along with other ad hoc and long-term projects assigned by the leadership team in Clinical Performance. These projects impact revenue and prepare us for health plan, CMS and HHS audits. The Senior Coding Analyst, Risk Adjustment will provide analytics, education, trainings to provider offices, and serve as the subject matter expert for all HCC coding initiatives, policies and procedures that adhere to our organizations coding guidelines and compliance standards. The position will interact with physicians, the provider network, and internal stakeholders within the organization (e.g. Provider Relations, Clinical Quality). The ability to develop and maintain key relationships across the company and provider network will be critical. The position may evolve to include Commercial; Medicaid, Quality and Social Determinants of Health (SDoH) capture as needed.

You will focus on:

• The Coding Analyst is responsible for reviewing, auditing, and coding medical records for the purpose of HCC reimbursement, training, education, and compliance.
• Meet daily productivity targets around HCC coding with 95% accuracy as well as office outreach and education.
• Audits and reviews medical documentation for appropriate ICD-10 and HCC coding and documentation
• Queries physicians when code assignments are not straightforward, or documentation is unclear.
• Reviews HCC and ICD-10 codes annually for accuracy and implements changes.
• Assists physicians and providers with questions and problems related to HCC coding and documentation.
• Assists physicians and providers with questions and problems related to coding and documentation.
• Supports organization on all levels of HCC coding audits (Internal Data Validation (IDV), Risk Adjustment Data Validation (RADV), Office of Inspector General (OIG), Department of Managed Healthcare (DMHC).
• Serves as a resource to team members.
• Serves as a resource to physician offices.
• This role may be responsible for 50% or more time meeting production standards.
• Demonstrates strong ability to work independently and problem solve.
• Demonstrates strong ability to clearly communicate, both verbally and in written format
• Demonstrates proficiency in Microsoft Suites, with an emphasis in Excel and Word
• Demonstrates strong ability to lead and/or facilitate meeting with internal and external stakeholders.
• Demonstrates excellent organizational skills.

The Skills, Experience & Education You Bring

• High school diploma or GED and equivalent of 2 years of relevant HCC coding experience.
• Bachelor's degree from an accredited school preferred.
• ICD-10 Certified Professional Coding Certification required.
• CRC Certification preferred.
• Current AAPC/AHIMA Certification preferred.
• Current advanced coding certification (Auditing, etc.) preferred.
• 3 - 5 years' experience of professional medical coding credentials (CPC, CRC and or similar).
• 3 - 5 years' experience in HCC coding and auditing (chart review).
• 1 or more years' experience in EPIC EMR software.
• 3 - 5 years' experience in Medicare Risk Adjustment.
• 1 or more years' project management and/or coordinating detailed projects or activities.
• 6 or more years' experience in a clinic setting, working directly with physicians and staff setting preferred.
• 6 or more years' experience and knowledge of Commercial and Medicaid coding, SDOH.

You Share our Mission & Values

• You are passionate about improving the healthcare experience and want to be part of the Altais mission.
• You are bold and curious- willing to take risks, try new things and be creative.
• You take pride in your work and are accountable for the quality of everything you do, holding yourself and others to a high standard.
• You are compassionate and are known as someone who demonstrates emotional intelligence, considers others when making decisions and always tries to do the right thing.
• You co-create, knowing that we can be better as a team than individuals. You work well with others, collaborating and valuing diversity of thought and perspective.
• You build trust with your colleagues and customers by demonstrating that you are someone who values honesty and transparency.

Altais values the contribution each Team Member brings to our organization. Final determination of a successful candidate's starting pay will vary based on several factors, including, but not limited to education and experience within the job or the industry. The pay scale listed for this position is generally for candidates that meet the specified qualifications and requirements listed on this job description. Additional pay may be determined for those candidates that exceed these specified qualifications and requirements. We provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.

The anticipated pay range for this role is listed in our salary posting for transparency but may vary based on factors including the candidate's qualifications, skills, and experience.

Altais and its subsidiaries and affiliates are committed to protecting the privacy and security of the personal information you provide to us. Please refer to our 'CPRA Privacy Notice for California Employees and Applicants' to learn how we collect and process your personal information when you apply for a role with us.

Physical Requirements: Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of workday.

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.