About Altais:
At Altais, we’re on a mission to improve the healthcare experience for everyone—starting with the people who deliver it. We believe physicians should spend more time with patients and less time on administrative tasks. Through smarter technology, purpose-built tools, and a team-based model of care, we help doctors do what they do best: care for people.
Altais includes a network of physician-led organizations across California, including Brown & Toland Physicians, Altais Medical Group Riverside, and Family Care Specialists. Together, we’re building a stronger, more connected healthcare system.
About the Role
Are you looking to join a fast-growing, dynamic team?
We’re a collaborative, purpose-driven group that’s passionate about transforming healthcare from the inside out. At Altais, we support one another, adapt quickly, and work with integrity as we build a better experience for physicians and their patients.
The Senior Coding Analyst will divide their time coding medical records for the purpose of HCC coding, including our annual health assessments, and working with our physicians on clinical documentation improvement. The Senior Coding Analyst, Risk Adjustment provides support and coding expertise to all programs that support risk adjustment and data validation efforts for our Medicare Advantage line of business, along with other ad hoc and long-term projects assigned by the leadership team in Clinical Performance. These projects impact revenue and prepare us for health plan, CMS and HHS audits. The Senior Coding Analyst, Risk Adjustment will provide analytics, education, trainings to provider offices, and serve as the subject matter expert for all HCC coding initiatives, policies and procedures that adhere to our organizations coding guidelines and compliance standards. The position will interact with physicians, the provider network, and internal stakeholders within the organization (e.g. Provider Relations, Clinical Quality). The ability to develop and maintain key relationships across the company and provider network will be critical. The position may evolve to include Commercial; Medicaid, Quality and Social Determinants of Health (SDoH) capture as needed.
You will focus on:
The Coding Analyst is responsible for reviewing, auditing, and coding medical records for the purpose of HCC reimbursement, training, education, and compliance
Meet daily productivity targets around HCC coding with 95% accuracy as well as office outreach and education
Audits and reviews medical documentation for appropriate ICD-10 and HCC coding and documentation
Queries physicians when code assignments are not straightforward, or documentation is unclear
Reviews HCC and ICD-10 codes annually for accuracy and implements changes
Assists physicians and providers with questions and problems related to HCC coding and documentation
Assists physicians and providers with questions and problems related to coding and documentation
Supports organization on all levels of HCC coding audits (Internal Data Validation (IDV), Risk Adjustment Data Validation (RADV), Office of Inspector General (OIG), Department of Managed Healthcare (DMHC).
Serves as a resource to team members
Serves as a resource to physician offices
This role may be responsible for 50% or more time meeting production standards.
The Skills, Experience & Education You Bring
High school diploma or GED and equivalent of 2 years of relevant HCC coding experience
3 - 5 years’ experience of professional medical coding credentials (CPC, CRC and or similar)
3 – 5 years’ experience in HCC coding and auditing (chart review)
1 or more years’ experience in EPIC EMR software
3 – 5 years’ experience in Medicare Risk Adjustment
1 or more years’ project management and/or coordinating detailed projects or activities
Preferred Qualifications
Bachelor’s degree from an accredited school
6 or more years’ experience in a clinic setting, working directly with physicians and staff setting
6 or more…