Junior Quality Improvement Coder Job at Astiva Health, Inc, Orange, CA

YTRRa3I1TnJ1MzdLK3ZjY2ZVdndTL0Nj
  • Astiva Health, Inc
  • Orange, CA

Job Description

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.

BENEFITS:

  • 401(k)
  • Dental Insurance
  • Health Insurance
  • Life Insurance
  • Vision Insurance
  • Paid Time Off

Job Tags

Similar Jobs

AdeIphi MedicaI Staffing

Interventional Radiologist #79558 Job at AdeIphi MedicaI Staffing

 ...Job Quick Facts Specialty: Interventional Radiology Job Type: Locum Tenens Facility Location: Hazard & Prestonsburg, KY Service Setting: Inpatient Reason For Coverage: Supplemental Coverage Period: Jun 9, 2025 - Ongoing Coverage Type: Clinical... 

Maania Consultancy Services

Cloud Engineer - TS/SCI Clearance Job at Maania Consultancy Services

 ...principles AWS Certified Developer Associate or Solution Architect, Similar certification in Azure or GCP preferred Certification in one of the Ci/CD tools preferrable Gitlab or Jenkins or attended courses in those ITIL Certification a plus CompTIA Security +... 

Greater Reach Community Services Board

Hospital and Community Liaison (208) Job at Greater Reach Community Services Board

 ...Community Services Board is seeking an experienced Masters level Clinician. This position serves as liaison between D19 and state hospitals for patients who have been civilly admitted to those facilities. Provides advanced level of inpatient hospital management and... 

West Earl Township Police Department

Translator/Interpreter Job at West Earl Township Police Department

 ...wide range of people with diverse voices, accents, speaking tempos and personalities. Providing parties with clear and exact translations of written materials, and interpretations of verbal communication. Providing interpretations of questions, answers, statements... 

China Global Connections

English ESL Teacher Job at China Global Connections

 ...looking for English Teachers for a Training Centerbased in Shenzhen. This is a full-time position starting as soon as possibleand hiring all year round. Job detailsTeach English as a second language (ESL) to K-12 studentsPrepare, deliver and reflect on lessons using...