Clinical Coding Educator (Temporary)
About The 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 or for those residing within the Pacific Standard Time zones. 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 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.
Requirements
- 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
- 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
- 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
- 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
Responsibilities
- 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
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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
501-1,000 employees
