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 ICD10 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 interdepartmental 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.

BENEFITS:

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

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.
• Strong understanding of coding principals including, HEDIS, Medicare Star ratings and Risk Adjustment.
• Strong understanding of the principals of HIPAA and able to maintain confidentiality.
• Able to build rapport with external providers and partners and internal teams.
• Professionally present data and findings that support internal goals and objectives.