Junior Quality Improvement Coder Job at Astiva Health, Inc, Orange, CA

TCtJdjJKVWtwdDY3bnA2dldiQmljcFArZ0E9PQ==
  • Astiva Health, Inc
  • Orange, CA

Job Description

Job Title: Junior Quality Improvement Coder

Target Compensation Range: $25.00 - $27.00/hour, depending on the relevant qualifications and experience.

About Us: Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members.

SUMMARY: The Junior Quality Improvement Coder is responsible for providing director support to all departmental QI initiatives. In this role, the Junior QI Coder will partner with the Director to collaborate with network providers and IPA’s to improve the quality of care through quality improvement activities that will include RAF, HEDIS, CMS Star Ratings and other health plan reporting.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:

  • Analyze data from contracted IPA network providers that allows for proper review of data to evaluate HEDIS and Risk Adjustment Factor.
  • Conduct internal reviews of documentation and billing on a timely basis.
  • Identify coding and billing risk areas, conduct focused reviews. Ensure accurate coding by utilizing official coding resources, Medicare manual and policies.
  • Collaborate and educate provider practices on CMS guidelines for Star Measures (Part C & D). Review and advise on appropriate documentation and coding for HEDIS and RAF reporting.
  • Prepare summary reporting of the coding review results as requested.
  • Participate in ongoing discussions concerning data collection and analysis for HEDIS gaps in care. Re-educate providers as needed.
  • Apply official CPT/HCPCS and ICD-10 coding guidelines, internal guidelines, and state specific Medicare/Medicaid coding instructions to review and analyze professionally coded services and coding queries.
  • Collaborate with internal departments and external partners to review and implement projects to improve delivery of services and quality of care.
  • Participate in provider and inter-departmental conference calls and meetings that support exceptional customer service.
  • Attend health plan meetings as requested by department leadership.
  • Regular and consistent attendance
  • Other duties as assigned

EDUCATION and/or EXPERIENCE :

  • 0 - 1 year of prior experience as a coder in a quality improvement role within a health plan, IPA or medical group.
  • Certified Coding certificate required.
  • Understanding of coding principals including, HEDIS, Medicare Star ratings and Risk Adjustment.
  • Strong understanding of the principals of HIPAA and able to maintain confidentiality.
  • Understanding of the difference between V28 vs. V24 models by CMS.
  • Able to build rapport with external providers and partners and internal teams.
  • Professionally present data and findings that support internal goals and objectives.

BENEFITS:

  • 401(k)
  • Dental Insurance
  • Health Insurance
  • Life Insurance
  • Vision Insurance
  • Paid Time Off

Job Tags

Similar Jobs

Town of Barnstable

SEAS Van Driver, Recreation Job at Town of Barnstable

 ...activities. Part time, seasonalMinimum Qualifications:CPR and First Aid Certification preferred.Current Valid Massachusetts drivers license or school bus driver certification.Must be 21 years of age or older.Must pass a CORI/SORI checkAdditional Qualifications... 

Hyatt

Housekeeper/Room Attendant - Full-Time ($1000.00 Sign On Bonus) Job at Hyatt

 ...Attendant/ Housekeeper is responsible for maintaining the cleanliness of the guest rooms assigned and assist with guest requests. Previous hotel cleaning experience is NOT required. Possess a valid driver's license Takes pride in a great job done A true desire to... 

KMRG, LLC

Witness Coordinator Job at KMRG, LLC

 ...national origin, age, marital or civil partnership status, mental disability, physical disability, medical condition, pregnancy, maternity status, political affiliation, military or veteran status, genetic information, traits historically associated with race, or any other... 

ING Americas

Associate, Sector Coverage - TMT Job at ING Americas

 ...institutional clients. When you come to work at ING, youre joining a team where...  ...model, allowing for in-office / work from home flexibility. Hybrid work arrangements vary...  ...adoption, surrogacy, and fertility services; student debt assistance; and subsidies for expenses... 

Advance2000

Digital Marketing Intern Job at Advance2000

 ...We are seeking a highly motivated and skilled Digital Marketing Intern to expand our digital marketing footprint and enhance our online visibility. The ideal candidate will have experience in SEO , Google Analytics , SEMRush , Google Search Console , and other...