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

Central California Alliance for Health (Remote)