Clinical Coding Educator

Summary

Join the Central California Alliance for Health as a Clinical Coding Educator (RN/LVN) in the Risk Adjustment Department. Reporting to the Risk Adjustment Director, you will serve as the 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. This role requires expertise in medical coding languages, risk adjustment payment models, and Medicare/Medi-Cal policies. The position offers a hybrid work environment and a competitive compensation package, including medical, dental, vision, paid time off, and retirement benefits.

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
• 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 provide education to providers on clinical coding standards
• Coordinate and lead 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