Date: 9/20/22

Organization: Preferred IPA of California (Thrifty Management)

Position: HCC/ Medicare Risk adjustment Coder

Employment type: Full-time

Location: Glendale, CA

Reporting: QI manager

Exemption: Hourly

Job Summary:

The HCC Coder will apply their experience, skills and techniques to manage/coordinate projects related to quality performance score improvement initiatives within the organization. The candidate will conduct provider educations on Quality Improvement metrics which includes but is not limited to HEDIS/Medicare STARs (Part C & D), Annual Wellness Visits/PAF/HOS/CAPHS, etc. The candidate will be responsible for the procurement of quality metric information (HEDIS/STARs/Annual Wellness Visits) from the medical records/charts from provider offices. The incumbent will work in conjunction with the Provider Representative, Compliance and Member Services departments to conduct outreach interventions to members and providers to impact overall quality performance. The incumbent will interface with various internal and external entities or other health care stakeholders (health plans, providers, etc.).

Experience:

· High School Diploma required. Preferred candidates with an Associate Degree or higher.

· Minimum 1 year working experience in healthcare quality improvement and managed care projects.

· Experience with HEDIS/STAR/Annual Wellness and Risk Adjustment strategies.

· Knowledge of EHR and EMR for encounter/claims data acquisition a plus.

· Experience working in a Medical Office

· Experience using Microsoft Office tools including Adobe Acrobat, Word, Excel and PowerPoint.

· Experience as a provider office biller or coder is a plus.

Job Responsibilities:

· Conduct HEDIS/Medicare STARs trainings for provider offices.

· Coordinate with provider offices to review and abstract EMR/EHR/Medical records impacting Annual Wellness, HEDIS/STARS performance.

· Work with provider offices to setup appointments for chart reviews/audits/abstractions at the physician offices.

· Distribute and follow-up with provider offices for outstanding Opportunity/Gap in Care Reports and train provider offices on best practices to improve on quality performance.

· Distribute and follow-up with provider offices on Annual Wellness Exam/Visits.

· Scan medical records and store in designated secured location.

· Local travel up to 80% or more.

· Have valid driver license and proof of car insurance.

· Other projects or responsibilities as assigned.

The successful candidate will:

· Demonstrate good verbal and written communication skills in English

· Bilingual (English and Spanish)

· Be comfortable interacting with internal and external entities.

· Act as an individual contributor, team lead, or team member for all assigned projects.

· Maintain good working relationship with provider offices/physicians.

· Have a solid understanding of the project scope and any tasks/items impacting deadlines.

· Adhere to company policies and procedures.

Certificates and Licenses:

· A current California Vocational Nurse license with no restrictions or

· A current licensed medical coder.

Job Type: Full-time

Pay: $65,000.00 - $75,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Work setting:

• Hybrid work
• Office

Education:

• High school or equivalent (Preferred)

Experience:

• HEDIS & HCC Coding: 3 years (Required)

License/Certification:

• Medical Coding Certification (Required)

Work Location: Hybrid remote in Glendale, CA 91202