Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first.We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.This is a remote position.The Coding Analyst, CDO is a core member of the Care Delivery Organization's coding team, serving as both a hands-on HCC coder and a provider-facing enablement resource for Alignment's contracted physician and clinical partners. Working closely with clinical documentation teams, and CDO provider partners — including PCPs, specialists, and clinical support staff — this role delivers accurate HCC code assignments, conducts structured provider coding audits, and provides targeted education that improves documentation quality and risk capture at the point of care. The Coding Analyst's work directly drives RAF score accuracy, revenue integrity, and the quality of clinical documentation across the CDO's provider network, making this role both a production function and a trusted clinical partner in Alignment's Medicare Advantage operations.Job Responsibilities:Review prospective and retrospective member medical records and assign accurate, compliant HCC codes using ICD-10-CM coding guidelines to support CMS Risk Adjustment submissions.Perform structured audits of provider documentation and coding practices for assigned physician groups and clinical staff — identifying patterns of under-documentation, missed conditions, and coding inaccuracies, and delivering specific, actionable feedback that drives measurable and sustained improvement.Develop and deliver targeted education on coding standards, CMS Risk Adjustment requirements, and clinical documentation best practices — tailoring content to the needs of PCPs, specialists, and clinical support staff across assigned CDO provider groups.Flag unsupported diagnoses, incomplete clinical documentation, and missing eligible conditions — communicating findings directly to providers and care teams to close risk capture gaps at the source and reinforce documentation standards.Apply current CMS Risk Adjustment coding rules, Official Guidelines for Coding and Reporting, and organizational policies to all coding and provider education activities — minimizing audit risk and ensuring submission integrity.Achieve daily coding productivity targets and maintain quality scores at or above established benchmarks, contributing directly to the CDO's RAF accuracy and performance goals.Stay current on ICD-10-CM updates, CMS Risk Adjustment model changes, and HCC coding guidance — applying changes promptly to all coding work and updating provider education materials accordingly.Ensure all coded data is entered accurately into applicable systems to support downstream risk adjustment reporting, encounter data submissions, and performance analytics used by CDO leadershipOther duties and projects not listed aboveSupervisory Responsibilities: Individual Contributor role.Job Requirements:Experience:Required:Minimum 2 years of experience in medical coding, with direct experience in Risk Adjustment or HCC coding in a Medicare Advantage, managed care, or health plan environmentDemonstrated experience with prospective and/or retrospective chart review codingWorking knowledge of ICD-10-CM coding systems and CMS Risk Adjustment methodologyExperience using electronic health record (EHR) systems and coding platformsPreferred:Experience coding in a high-volume Medicare Advantage health plan or delegated risk modelFamiliarity with CMS RADV audit processes and encounter data submission requirementsExperience with coding productivity and quality tracking toolsEducation:Required:High school diploma or equivalent required; associate's or bachelor's degree in Health Information Management, Medical Coding, or a related field preferredEquivalent combination of education and coding experience in Medicare Risk Adjustment will be consideredPreferred:Associate's or bachelor's degree in Health Information Management or a related fieldTraining:Required:Formal training in ICD-10-CM coding and CMS Risk Adjustment methodology, through an accredited coding program or demonstrated equivalent experiencePreferred:AAPC or AHIMA-approved coding education or certification preparation courseworkContinuing education in CMS HCC model updates and Risk Adjustment complianceSpecialized Skills:Required:ICD-10-CM Coding (Proficient): Accurate application of ICD-10-CM diagnosis codes to medical records in compliance with Official Coding Guidelines and CMS Risk Adjustment rules.HCC Coding and Risk Adjustment Knowledge (Proficient): Working knowledge of the CMS-HCC Risk Adjustment model, hierarchical condition categories, and how diagnosis coding translates to RAF scores and plan revenue.Medical Record Review (Proficient): Ability to navigate and interpret clinical documentation across multiple record types — including physician notes, discharge summaries, and diagnostic reports — to identify codeable conditions.Coding Compliance and Audit Readiness (Proficient): Understanding of coding accuracy standards, documentation requirements, and CMS audit expectations — with the ability to identify and escalate non-compliant documentation.EHR and Coding System Proficiency (Working Knowledge): Competence with electronic health records and coding workflow platforms used to retrieve, review, and submit coded data.Attention to Detail and Productivity Management (Proficient): Ability to maintain high accuracy and consistent output in a remote, high-volume coding environment with independently managed workloads.Clinical Documentation Integrity Awareness (Working Knowledge): Familiarity with CDI principles and the ability to recognize documentation gaps that affect HCC capture and coding completeness.Preferred:Licensure:Required:CPC (Certified Professional Coder) — AAPC; ORCCS (Certified Coding Specialist) — AHIMA; ORRHIT (Registered Health Information Technician) — AHIMAPreferred:CRC (Certified Risk Adjustment Coder) — AAPCCDEO (Certified Documentation Expert Outpatient) — AAPC
18 days ago