Job Description

About Our Company At Altais, we're looking for bold and curious clinicians and innovators who share our passion for enabling better health care experiences and revolutionizing the healthcare system for physicians, advanced care providers, patients, and the clinical community. At Altais, we're building breakthrough clinical support tools, technology, and services to let doctors do what they do best: care for people. We invite you to join our growing passionate team as we change the game for the future of healthcare and enable the experience that people need and deserve. Altais family of companies include Brown & Toland Physicians, Family Care Specialists and Altais Medical Groups. About Your Team Are you looking to work with a high performing, fast growing and dynamic project management team? We are 4,000+ physicians, working in over 40 cities throughout California, caring for more than 500,000 patients. If you are passionate about reshaping healthcare and want to work for a mission driven organization where new ideas and innovation are valued, then we would like to meet you. About Your Work The Business Integrity and Compliance Specialist will play a pivotal role in Altais's Compliance department by leading investigations into possible fraud, waste, and abuse (FWA), and utilizing data analysis to monitor trends and patterns that may indicate compliance risks. This individual will play a leading role in the Special Investigations Unit (SIU) and will identify opportunities for improvement in business departments such as Revenue Cycle Management and Claims. You Will Focus On: Review and analyze medical coding data to identify patterns or anomalies that may indicate fraudulent or abusive practices. Conduct periodic audits and assessments of coding practices to identify potential compliance issues or areas for improvement, and to ensure ongoing accuracy and adherence to policies. Participate in educational calls with providers and explain findings in a way to increase billing and coding compliance going forward. Collaborate with other departments to investigate possible FWA that has been identified through data analysis or reported to Compliance. Develop, review, and update internal policies and procedures related to business integrity and compliance to ensure they reflect current requirements and best practices. Prepare and present regular reports to management on compliance status, coding audit results, and business integrity issues. Provide insights and recommendations for improving compliance programs. Work closely with various departments to ensure alignment with compliance objectives and to promote a culture of ethical behavior and integrity within the organization. The Skills, Experience & Education You Bring Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) or Bachelor's degree in related area. Minimum 3 years' experience in coding and chart auditing. Experience with electronic health record and billing systems required. Experience investigating possible Fraud Waste and Abuse in a managed care setting, such as a health plan or delegated physician group. In-depth knowledge of ICD-10, CPT, and HCPCS coding systems. Proficient in navigating medical billing systems and coding software. Strong analytical and investigative skills with attention to detail. Excellent written and verbal communication skills. Advanced understanding of healthcare FWA regulations, compliance frameworks, risk management and internal controls, and industry standards. Approved American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC) coding credential required, including CCS, CPB, or CPC - Required. Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AFHI) - preferred. You Share our Mission & Values You are passionate about improving the healthcare experience and want to be part of the Altais mission. You are bold and curious - willing to take risks, try new things and be creative. You take pride in your work and are accountable for the quality of everything you do, holding yourself and others to a high standard. You are compassionate and are known as someone who demonstrates emotional intelligence, considers others when making decisions and always tries to do the right thing. You co-create , knowing that we can be better as a team than individuals. You work well with others, collaborating and valuing diversity of thought and perspective. You build trust with your colleagues and customers by demonstrating that you are someone who values honesty and transparency. 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, experience, and geographic location. This base pay range is specific to California and can vary based on Bay Area, Metro LA, and Greater California regions which may not be applicable to other locations. 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. Physical Requirements: Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of workday. 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. Altais, Inc.

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