Risk Adjustment Provider Engagement Lead - Remote

The Risk Adjustment Provider Engagement Lead is responsible for building relationships with external physicians, conducting medical record reviews, monitoring coding patterns, and providing onsite education to improve documentation quality and ensure compliance with CMS guidelines. This role involves collaboration with clinical and analytics teams to support risk adjustment programs.

Location: Remote

Salary: $70,823.00 - $106,234.00

Responsibilities

• Validates provider documentation for accuracy by reviewing and analyzing samples of coding and claims extracts compared to actual medical records.
• Develops education materials to assist physicians in accurately assessing patients’ overall health status.
• Provides feedback to providers on performance improvement opportunities; tracks and prioritizes projects to improve coding and documentation outcomes.
• Maintains a comprehensive tracking and management tool for assigned physicians within Alignment Health's provider network.
• Identifies issues, determines impact to risk adjustment models, and reports results timely to ensure that physicians remain in compliance.
• Collects, analyzes, and shares MRA performance data through clear presentations and detailed reports, including outreach priorities, HCC gap data, and encounter status insights for use through Joint Working Groups (JWGs) with internal and external stakeholders.
• Collaborates with internal and external coding, analytics, and clinical teams to ensure accurate and complete diagnosis coding and HCC Gap Closures.
• Presents progress and results to leadership on a routine basis.
• Assists with CMS Risk Adjustment Data Validation activities to ensure external physicians and Alignment Health care are prepared for audits.
• Regularly updates all Risk Adjustment materials with clinical and/or official guideline changes.
• Suggests, updates, and enhances clinical educational materials to assist in training physicians and clinical staff on Risk Adjustment Healthcare Programs including CMS-HCC Models, Clinician Chart Reviews, and Encounter Documentation.
• Suggests customizations of Risk Adjustment education for various audiences; Support Staff, PCPs, Specialists, Employees vs. contracted and Central Departments.
• Stays current on industry coding, compliance, and HCC issues.
• Utilizes, protects, and discloses Alignment Health care patients’ protected health information (PHI) only in accordance with HIPAA standards.
• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies.
• Local travel is required.

Requirements

• Three-five years of coding in a medical group or health plan setting required; Professional Coding experience required.
• Experience with strategic planning in risk mitigation.