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

cDJaZ3FQWWVBTitYcEVXR2tsbGlZeHhWaWc9PQ==
  • 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

Sayville Ford

Customer Experience Coordinator Job at Sayville Ford

JOB SUMMARY: We are looking for 2 Customer Experience Coordinators to join our growing team! The right candidates will have strong communication skills and the ability to handle different tasks, and will act as liason between the service and sales departments. The day-... 

Brown & Riding

Production Associate - Wholesale Insurance Brokerage - MLPL Job at Brown & Riding

 ...the broker team by marketing basic submissions/accounts. The remainder of their time is spent assisting the broker team in meeting the day-to-day technical and clerical needs by servicing active and expired policy files; all in accordance with established Brown & Riding... 

24 Seven Talent

Studio Associate Job at 24 Seven Talent

 ...known furniture company based in Portland, OR to help them find a Studio Associate to join their team this week! They need someone who...  ...tools and working in a wood shop is a plus Ability to keep accurate records and follow documented procedures and standards... 

Clayco

Commercial Cleaner Job at Clayco

 ...after business hours, from 4:00 PM to 12:00 AM. Your efforts will ensure that offices, restrooms, and shared spaces are consistently clean, safe, and prepared for use the next business day. Were looking for someone reliable, detail-oriented, and capable of working... 

Eximia Research

Clinical Research Coordinator Job at Eximia Research

 ...The Clinical Research Coordinator conducts and manages clinical trials in accordance with the study protocol, GCP, and Eximia Research...  ...by state law Required Skills: Demonstrated knowledge of medical terminology Demonstrated ability in the use of the following...