Clinical Coding Educator

Summary

Join the Central California Alliance for Health as a Clinical Coding Educator (RN/LVN) in the Risk Adjustment Department. This role involves acting as a clinical coding subject matter expert, educating providers on coding standards, and leading the Alliance Coding Workgroup. The ideal candidate possesses a strong background in clinical coding and documentation education, with RHIA and CCS certifications. Responsibilities include assigning clinical codes, conducting research, and making presentations. The position requires a current RN or LVN license, RHIA and CCS certifications, a Bachelor's degree (or equivalent), and at least eight years of experience, including three years of clinical experience and five years of CDI experience. The Alliance offers a hybrid work environment and a comprehensive benefits package.

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
• 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

Responsibilities

• Act as the clinical coding subject matter expert and lead coding resource across the organization
• Act 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