Coding Education & Compliance Specialist - Rio Grande Valley, TX

At CareAllies, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Job Summary

Under supervision, this position is responsible for conducting provider trainings on health plan coding initiative guidelines and requirements of the Risk Adjustment program to ensure correct coding and documentation. This position will customize presentations to educate providers and staff and develop relationships with clinical providers and staff. This position will also research and analyze the medical records when there is a discrepancy in coding, and validate the coding and support the department to report findings. This position audits medical records to ensure compliance with the organizations coding procedures and standards according to the CMS coding guidelines and official icd9 / icd10 coding guidelines. The individual in this role must have the ability to travel up to 60% of the time within the assigned market. This position will evaluate documentation to ensure that diagnosis coding is supported and meets specificity requirement to support clinical indicators, HEDIS and STARS quality measures. This position will also work closely with matrix partners including Provider Engagement, Stars, Clinical and Population Health teams as well as vendors to ensure provider office communications are effective and efficient.

Job Requirements

• High School Diploma or GED.
• CPC Coding Certification/CPC, CCS, CCSP
• 2 years medical coding experience
• Experience with process management
• PC experience and skills to include Microsoft Office
• Verbal and written communication skills
• Analytical skills
• Ability to travel 20% - 30% of the time in and out of state
  
  

Preferred Job Requirements

• Associate or Bachelor’s degree
• CRC
• Experience in health insurance or health care setting
• Previous experience working on Risk Adjustment coding for either Medicare Advantage or Retail Exchange business
• Prior experiences teaching/training others on correct coding guidelines and/or have the ability to present to large groups of Physicians/Providers.
• Client-Site Location: This is a field based position and requires the individual to be at provider offices up to 3 days weekly within the assigned market.
• Market Assignment: Rio Grande Valley, TA, including McAllen, Harlingen, and surrounding areas.
• Schedule: Monday – Friday. Will require occasional evening meetings, and infrequent Saturdays.
• Sponsorship: This role does not offer sponsorship.
  
  

INAK

EEO Statement

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Pay Transparency Statement

At CareAllies, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, a minimum of 15 days’ of paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for full-time employees.

The salary offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

Min To Max Range

$46,600.00 - $84,300.00