Job Details

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 Risk Adjustment & Quality Educator is part of the Altais Risk Adjustment & Quality team and provides coding support for Altais's clinicians. The Educator measures accuracy and general completeness of medical record documentation to assess the appropriateness of code assignments, such as ICD-10-CM and CPT II codes with Federal and State requirements for professional fee billing and medical record documentation.

This role requires you to travel to provider offices 75% of the time in Northern California and state-wide as needed.

You will focus on:

• Manage multiple projects, including coding updates, revenue cycle management-related reporting and analytics and process improvement initiatives with the medical groups.
• Accountable for reviewing and assigning accurate CPT II and ICD-10 CM Codes for outpatient and inpatient professional services for the Altais provider network
• Ensuring the accuracy of all medical documentation and establishing compliance with the Health Insurance Portability and Accountability Act (HIPAA) and other government regulations
• Performs coding analysis and supports end users and business partner's needs; identifies and communicates coding risk areas, providing mitigation strategies and recommendations to various stakeholders.
• Accountable for working with the Director of Risk Adjustment & Quality to address improving processes and tools used to document and code clinical services provided by Altais's providers throughout the enterprise to meet changing business and regulatory conditions.
• Set objectives for documentation and track performance against those objectives with key stakeholders.
• Work in partnership with Operation's administrators to coordinate the development of education programs relative to coding and documentation improvement.
• Collaborate with Operation's administrators and providers to review and update orientation and educational materials, documentation tip sheets and training programs/resources.
• Assess Altais's clinical systems to ensure the accurate and complete capture of clinical information that can be extracted and transmitted to payers, regulators, and other parties.
• Collaborate with Legal & Compliance to review proposed regulatory changes and provide subject matter expertise regarding associated impacts to Altais's clinical operations.
• Anticipate and effectively address short- and long-term effects of regulatory and industry standard changes to business processes.
• Coordinate with and supports Altais's leaders in meeting strategic and operational goals concerning documentation, coding, and reporting.
• Develops a regular meeting series to provide consistent coding and documentation feedback and training to clinicians.
• Collaborate and manage risk adjustment reports and work queues across various verticals
• Create process maps and documentation to improve workflows impacting the revenue cycle; evaluate whether process changes improved results; conduct education sessions about new procedures.
• Responsible for researching and providing accurate coding for rejected claims; works and resolves charge edit work queues daily.
• Acts as primary coding resource for medical groups including abstraction of complex surgical reports.
• Must abide by the standards of Ethical Coding and adhere to all official coding guidelines.
• Accountable for reviewing coding of hospital-based services.
• Attends internal coding review team meetings for continued learning and knowledge advancement.
• Utilizes superior customer service to clearly communicate opportunities to improve documentation and coding practices, using knowledge of both government and non-government coding trends and reimbursement rules.
• May be accountable for, or assist in, entering demographic and insurance information into the electronic medical record (Epic) for hospital-based services.
• May support special projects related to reimbursement analysis, new service line development and electronic medical record implementation
• Northern California, Bay Area 50% travel to local provider(s) offices and provider network for Altais

The Skills, Experience & Education You Bring

• Associate degree or 3+ years of relevant experience
• 5+ years of related professional Risk Adjustment & Quality education experience required.
• 2+ years of experience with ICD-10 CM
• Experience providing training and education to staff and clinicians using excellent verbal and written communication skills, effective technical skills, have positive demeanor and exhibit professionalism in approach
• Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC) required
• Awareness of Quality measures and the importance of quality gap closure.
• Must demonstrate expertise in medical coding guidelines and regulations, including compliance and reimbursement rules.
• A strong understanding of physiology, anatomy and medical terminology.
• Expertise in denials management identifying root causes and proposing solutions.
• Ability to maintain a high level of integrity and confidentiality of medical information.
• Organization skills
• Strict attention to details
• Detail oriented with excellent written and verbal communication
• Unparalleled multi-tasking abilities
• Critical thinking skills
• Ability to react to resets and changes in a fast-paced environment
• Able to learn and work with a variety of different tools and applications required for the role

Preferred Experience

• Experienced educator with a strong understanding of the requirements for clinical coding and CPT II billing according to the rules of Medicare, Medicaid, and commercial payers
• Electronic medical record and chart review experience

Base Salary

$100,000 - $120,000/yr

You Share Our Mission & Values:

Compassion

We act with empathy and a deep respect for the challenges faced by physicians and their patients. Our work is driven by a genuine commitment to improving lives and ensuring that care is delivered with dignity, understanding, and humanity.

Community

We foster a culture of collaboration--with physicians, patients across the healthcare ecosystem, and among our teams. By building strong, trusted relationships, we create a unified community focused on advancing patient care and physician well-being.

Leadership

We lead with integrity and vision, setting the standard for excellence in physician support and healthcare innovation. Through collaboration and expertise, we empower others to lead, drive change, and shape the future of care.

Excellence

We are relentlessly focused, results-driven, and accountable for delivering measurable value to physicians and the patients they serve. Our high standards reflect our commitment to excellence, operational discipline, and continuous improvement.

Agility

We embrace change as a constant and respond swiftly to the evolving needs of the healthcare industry. With flexibility and forward-thinking, we adapt, innovate, and act decisively to keep physicians at the forefront.

Altais values the contribution each Team Member brings to our organization. Final determination of a successful candidate's starting pay will vary based on several factors, including, but not limited to education and experience within the job or the industry. The pay scale listed for this position is generally for candidates that meet the specified qualifications and requirements listed on this job description. Additional pay may be determined for those candidates that exceed these specified qualifications and requirements. We provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.

The anticipated pay range for this role is listed in our salary posting for transparency but may vary based on factors including the candidate's qualifications, skills, and experience.

Altais and its subsidiaries and affiliates are committed to protecting the privacy and security of the personal information you provide to us. Please refer to our 'CPRA Privacy Notice for California Employees and Applicants' to learn how we collect and process your personal information when you apply for a role with us.

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.