Clinical Coding Educator (Temporary)

Central California Alliance for Health

1d • $67 - $75 • Hybrid

About The Position

This is a temporary position and the length of assignment is estimated to go through July 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. 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. 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

Requirements

• 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
• 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
• Knowledge of the relationship between diagnosis documentation and risk adjustment payment models
• Knowledge of CMS Hierarchical Condition Categories (HCC) Risk Adjustment program, methodology, and impact to value-based contracts
• Knowledge of principles and practices of internal data auditing
• Knowledge of 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
• Ability to accurately assign clinical codes and act as the final decision maker regarding clinical code assignments
• Ability to 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
• Ability to organize work, manage multiple tasks, establish priorities, adjust to changing priorities, and meet deadlines
• Ability to make presentations and facilitate and lead meetings and workgroups

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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 501-1,000 employees