Job description
We have an opportunity to join the Alliance as a Clinical Coding Educator (RN/LVN) in the Risk Adjustment Department.
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
To read the full position description, and list of requirements click here.
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
- 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
- Medicare and Medi-Cal coding policies
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
- Make presentations and facilitate and lead meetings and workgroups
Education and Experience:
- Current unrestricted license as a Registered Nurse or Licensed Vocational Nurse issued by the State of California
- Current certification as a Registered Health Information Administrator (RHIA) and Certified Coding Specialist (CCS) issued by the American Health Information Management Association
- Bachelor’s degree in Nursing, Health Care, or a related field
- A minimum of eight years of experience including a minimum of three years of clinical experience and a minimum of five years of CDI (clinical documentation integrity) experience with emphasis on Medi-Cal and Medicare requirements in a managed care environment 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.
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 transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).
Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego area
Typical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area
Zone 1 (Monterey, San Benito and Santa Cruz)
$100,161—$160,264 USD
Zone 2 (Mariposa and Merced)
$91,144—$145,850 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.
