Get AI-powered advice on this job and more exclusive features. This range is provided by Astiva Health, Inc. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range $25.00/hr - $27.00/hr Direct message the job poster from Astiva Health, Inc 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.
...hiring EMS Call Receivers that will respond to emergency and non-emergency calls for ambulance and transportation services. This person assigns and routes transportation... ...adequately implements the concepts of Emergency Medical Dispatch as published in Principles of Emergency...
...both certified substitute paraprofessionals and those with no teaching experience. Our hiring coordinators are ready to help you through the... ...process. \nJob Description:\n A substitute paraprofessional assists the classroom teacher to provide extra support to students...
...Description We are looking for a dedicated Health Coach to join Us Orion's Coaching department. As a Health Coach, you will play a crucial role in promoting health and wellness within the organization. Your primary focus will be on providing guidance and support to...
...potentialand a chance to give something back. Come join the family that works together to sustain success. Seeking applicants for Boiler Operator. We have multiple openings throughout our Company. The position requires a minimum of a 2b license. Apply now to join our...
...Job Description Job Description Orizon Energy is hiring new and experienced Solar Sales professionals for in-field positions in Calgary, AB. Candidates should have effective communication skills, a self-starter mindset, and a passion for renewable energy. Responsibilities...