• Job Description

  Req#: 30f09605-3ef0-473d-83ec-681d751ae72b
  Risk Adjustment QA Specialist
  
  Department: Quality - Risk Adjustment
  
  Employment Type: Full Time
  
  Location: 600 City Parkway West 10th Floor, Orange, CA 92868
  
  Compensation: $90,000 - $100,000 / year
  
  Description
  
  Astrana Health is seeking an experienced Risk Adjustment QA Specialist to join our team. In this role, you will ensure accurate and compliant documentation through chart audits, provider education, and ongoing monitoring. You will deliver actionable feedback to HCC coding auditors and providers within the Astrana Health network, helping to improve documentation practices and meet regulatory standards.
  
  What You'll Do
  
  • Abstract pertinent information from assigned medical records using ICD-9-CM, ICD-10-CM, CPT and/or HCPCS codes.
  • Provide detailed comments/feedback on physician performance based on encounter audits.
  • Document detailed chart audit findings including all documentation errors; medical record errors; diagnosis errors as well as missed HCC opportunities.
  • Identify documentation training and HCC coding review training opportunities.
  • Encounter audits will be the primary monitoring tool used to identify operational and regulatory issues related to coding, documentation, and compliance requirements and to ensure complete and accurate data capture in compliance with Federal and State requirements.
  • Monitor corrective actions for audit review findings.
  • Serves as a local resource in meeting internal and external regulatory requirements (e.g., Centers for Medicare & Medicaid Service (CMS), National Committee for Quality Assurance (NCQA)).
  • Actively participate with local CMS (Center for Medicare/Medical Services) team to ensure local objectives are met and regional CMS compliance activities are supported.
  • Works with medical center leadership to provide confidential audits and feedback on an "as needed" basis.
  • Assist in the identification of operational processes that hinder encounter data capture.
  • Prepare and/or perform auditing analysis and/or special projects as assigned.
  • Provide feedback on noncompliance issues detected through auditing.
  • Provide audit support to the HCC Risk Adjustment program specifically the yearly Wellness Visit Program.
  • Submit bi-weekly and monthly audit finding reports.
  
  
  Qualifications
  
  • High School Diploma or equivalent. Bachelor's degree preferred.
  • 5+ years of experience in a healthcare setting related to HCC Risk Adjustment and chart auditing
  • Current AAPC or AHIMA certification (CCS, CCS-P, CPC, CPC-H, CPC-P, RHIT, or RHIA)
  • Strong understanding of CMS Risk Adjustment guidelines, ICD coding, and compliance requirements
  • Excellent written and verbal communication skills with the ability to educate providers
  • Strong analytical and problem-solving skills
  • Ability to work independently and manage multiple priorities in a fast-paced environment
  • Proficiency with Microsoft Word, Excel, and Outlook
  
  
  Environmental Job Requirements and Working Conditions
  
  • This is a remote role within the United States. The home office is aligned with your department at 600 City Parkway West, 10th Floor, Orange, CA 92868.
  • The target pay range for this role is: $90,000 - $100,000. This salary 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 on 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 based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.
  
  Additional Information:
  
  The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

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