Risk Adjustment Coding Educator (Temporary) at Central California Alliance for Health

, California, United States -

Full Time

Start Date

Immediate

Expiry Date

22 Apr, 26

Salary

72.0

Posted On

22 Jan, 26

Experience

10 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Coding, Documentation Education, Risk Adjustment Coding, Communication Skills, Attention to Detail, Auditing Practices, Cross Functional Leadership, Medical Coding Languages, Training Development, Project Management, Data Auditing, CMS HCC Risk Adjustment, EMR Coding Standards, Medicare Coding Policies, Clinical Documentation Improvement, Research Skills

Industry

Hospitals and Health Care

Description

OUR COMMITMENT TO A HUMAN HIRING PROCESS We believe every candidate deserves thoughtful consideration. That’s why we do not use AI or automated systems to review applications. Every application is reviewed by a real human member of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer — and we genuinely appreciate your patience as we work through applications carefully and respectfully. SERVICE AREA PREFERENCE While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission of accessible, quality health care guided by local innovation leads everything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment. ABOUT THIS TEMP POSITION This is a temporary position and the length of assignment is estimated to go through December 2026. The length of the assignment is always dependent on business need and dates may change. While the assignment would be at the Alliance, if selected, you would be an employee of a temporary employment agency that we would connect you with. WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Risk Adjustment Director, this position: Acts as the clinical coding subject matter expert and lead coding resource across the organization Acts as a resource and provides education to providers on clinical coding standards Coordinates and leads the Alliance Coding Workgroup ABOUT THE TEAM Risk Adjustment is a growing, specialized team that plays a critical role in ensuring accurate coding, appropriate reimbursement and data-driven insights that support the broader organizational goals of our health plan. Our team collaborates closely with internal and external partners to optimize risk adjustment performance across our future Medicare and current Medi-Cal programs. We are passionate about using data to improve our members' health outcomes, support the success of our provider partners, and ensure regulatory alignment. THE IDEAL CANDIDATE Strong background in clinical coding and documentation education with current certification as a Registered Health Information Administrator (RHIA) and Certified Coding Specialist (CCS) Demonstrated experience in supporting the development and implementation of clinical documentation improvement (CDI) programs Excellent communication skills with the ability to clearly explain complex regulatory or clinical coding concepts to diverse audiences Meticulous attention to detail with a strong foundation in auditing practices Experience leading cross functional workgroups WHAT YOU'LL NEED TO BE SUCCESSFUL Knowledge of: Medical coding languages, concepts, guidelines, methodologies, and regulations related to all sites of service, including knowledge of ICD-10, CPT, and HCPCS coding systems Principles and practices of training, including training content development for providers and staff The relationship between diagnosis documentation and risk adjustment payment models CMS Hierarchical Condition Categories (HCC) Risk Adjustment program, methodology, and impact to value-based contracts Principles and practices of internal data auditing Electronic Medical Record (EMR) coding standards Medicare and Medi-Cal coding policies The principles and practices of conducting and responding to audits The principles and practices of project management Ability to: Act as a subject matter expert and technical resource and explain policies, regulations, terms, and procedures related to area of responsibility Accurately assign clinical codes and act as the final decision maker regarding clinical code assignments Conduct research, gather and interpret information and data, identify issues of concern, make logical recommendations for action, and present findings in a clear and organized manner Organize work, manage multiple tasks, establish priorities, adjust to changing priorities, and meet deadlines Interpret and apply policies, standards, and guidelines Make presentations and facilitate and lead meetings and workgroups Develop training materials and conduct internal and external training Foster effective working relationships and communicate clearly and effectively with external and internal stakeholders and individuals at all levels of the organization Education and Experience: Current certification as a Certified Coding Specialist (CCS) issued by the American Health Information Management Association and as a Certified Risk Adjustment Coder (CRC) issued by the American Academy of Professional Coders Bachelor’s degree in Health Care, Business, Nursing, or a related field A minimum of eight years of experience including a minimum of three years of clinical experience and a minimum of eight years of risk adjustment coding experience which included provider education responsibilities (an Associate’s degree and an additional two years of experience may substitute for the Bachelor’s degree); or an equivalent combination of education and experience may be qualifying OTHER INFORMATION We are in a hybrid work environment, and we anticipate that the interview process will take place remotely via Microsoft Teams. While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process. This is a temporary position and does not provide the benefits that are listed below (this is standard language from our regular job posts and cannot be altered or removed). Temporary employees on assignment at the Alliance will be connected to a staffing agency with separate benefit options. The full compensation range for this position is listed by location below. The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location). Zone 1 (Monterey, San Benito and Santa Cruz) $67—$72 USD Zone 2 (Mariposa and Merced) $62—$67 USD OUR BENEFITS Medical, Dental and Vision Plans Ample Paid Time Off 12 Paid Holidays per year 401(a) Retirement Plan 457 Deferred Compensation Plan Robust Health and Wellness Program Onsite EV Charging Stations And many more ABOUT US We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer Join us at Central California Alliance for Health (the Alliance) is an award-winning regional Medi-Cal managed care plan that provides health insurance for children, adults, seniors and people with disabilities in Mariposa, Merced, San Benito and Santa Cruz counties. We currently serve more than 418,000 members. To learn more about us, take a look at our Fact Sheet. At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

Responsibilities

The Risk Adjustment Coding Educator will act as the clinical coding subject matter expert and provide education to providers on clinical coding standards. They will also coordinate and lead the Alliance Coding Workgroup.