Risk Adjustment Coding Educator (Temporary)

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 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).