About the Role:
Under the Quality department, the Clinical Operations team leads the efforts that improves health outcomes by coordinating and delivering key clinical care. Through outreach and education, we inspire patients to take a preventive approach to maintaining their health and to be active in their chronic disease management. Together, we strive to achieve healthy living for all through all stages of life.
As a Medical Coder, you are part of a patient-centered team that provides support for our clinical teams. You will follow up on post-visit documents from clinical providers, communicate and review documentation issues and queries with providers, and enter accurate codes for claims across our various programs. This role will report to the Coding & Billing Supervisor.
What You’ll Do:
- Review provider documentation of diagnostic data from medical record to verify that all Medicare Advantage and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company
- Review medical record information on both a retroactive and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC)
- Perform thorough review on the surveys and medical records provided by our nurse practitioners to ensure ICD-10- CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines
- Interacts with our team of providers regarding coding, billing, documentation policies, procedures, and conflicting/ambiguous or non-specific documentation
- Verify patient eligibility with insurance as needed, maintaining an open line of communication with all insurance carriers including follow-up, denials, and appeals
- Bill, post, review, and analyze superbills from providers to ensure accuracy in codes as per billing guidelines
- Other duties in support of department programs and goals
Qualifications:
- High School diploma/GED or higher education
- Must possess and maintain AAPC or AHIMA certification, & Certified Coding Specialist (CCS-P), CCS, CPC
- Minimum of two years of experience in medical coding
- PC skills and experience using Microsoft applications such as Word, Excel, and Outlook
You’re great for this role if you have:
- Certified Risk Adjustment Coder (CRC)
- Knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage
- General knowledge of medical billing
- Knowledge in insurance verification & eligibility
- Experience with Medicare STAR metrics and HEDIS measures
- Experience using EHR systems
- Honesty, integrity, and team-oriented mentality
- Value quality over quantity
Who We Are:
Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.
Our platform currently empowers over 10,000 physicians to provide care for ~1 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.
Our Values:
- Put Patients First
- Empower Entrepreneurial Provider and Care Teams
- Operate with Integrity & Excellence
- Be Innovative
- Work As One Team
Environmental Job Requirements and Working Conditions:
- This is a remote position. The home office is located at 568 W. Garvey Ave., Monterey Park, CA 91754.
- The total compensation target pay range for this role is: $19.00-24.00 per hour. The range represents our national target range for this role.
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at [email protected] to request an accommodation.