Risk Adjustment Coding Educator (Temporary)

OUR COMMITMENT TO A HUMAN HIRING PROCESS

We believe every candidate deserves thoughtful wedo not use AI or automated systems toreview applications. Every application is reviewed bya realhumanmember 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 ofaccessible quality health care guided by local innovationleadseverything 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.

This position can be filled remotely for those residing in California.

WHAT YOULL 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 YOULL 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
• Bachelors 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 Associates degree and an additional two years of experience may substitute for the Bachelors 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.

COMPENSATION INFORMATION

The posted hiring ranges below represent a goodfaith estimate of what a temporary employee would be paid on this assignment. Final compensation will be determined by our compensation philosophy analysis of the selected candidates qualifications (direct or transferable experience related to the position education or training) as well as other factors (internal equity market factors and geographic location).

The applicable salary ranges are based on work location and are aligned to a zone according to the cost of labor in your area. All ranges are subject to change in the future. We are happy to answer any questions that you have or share the applicable pay zone for your location if its not one of the typical areas included below. You can reach out to and a member from our Talent Acquisition team will be in touch.

Typical areas in Zone 1: Santa Cruz San Benito and Monterey Counties Bay Area Sacramento Los Angeles and San Diego areas

Typical areas in Zone 2: Mariposa and Merced Counties Fresno area Bakersfield Eastern California San Luis Obispo area and the Central Valley (except Sacramento)

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 418000 members. To learn more about us take a look at ourFact 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.