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Risk Adjustment Provider Engagement Lead
Alignment HealthRisk Adjustment Provider Engagement Lead responsible for coding quality and provider education. Ensure compliance and accurate documentation for healthcare services with interdisciplinary team.
About the role
Key responsibilities & impact- 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
Requirements
What you’ll need- 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
- Proficiency in MS Officer suite including Access
- Previous use of Epic, Allscripts, EZCap a plus
- Current driver’s license
- CPC, CPC-H, CCS, CCS-P, RHIT, RHIA, OR CPMA
Benefits
Comp & perks- Local travel is required
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
codingclaims analysisrisk adjustmentdata validationdiagnosis codingHCC gap closurestrategic planningdata analysispresentation skillsproject management
Soft Skills
collaborationcommunicationfeedback provisionperformance improvementtrainingorganizationproblem-solvingadaptabilityleadershipattention to detail
Certifications
CPCCPC-HCCSCCS-PRHITRHIACPMA