Certified Coding Specialist Sr (HCC-Medicare and Medi-Cal)

Dice; United States; Remote; USD 68,000 - 109,000; Full time

Job summary

A leading health plan in Orange County is seeking a Certified Coding Specialist Sr to manage coding compliance and risk adjustment initiatives. This role requires expertise in audits and coding accuracy, alongside strong communication skills. The position offers a flexible telework arrangement, aiming to enhance healthcare quality in the community.

Benefits

Comprehensive health insurance

Retirement plans

Wellness programs

Diversity and equal opportunity employment

Qualifications

• 5 years of risk adjustment coding and audit experience, or equivalent.
• Current CCS or CPC certification from AHIMA or AAPC.

Responsibilities

• Conduct audits and assess coding accuracy (80% of the role).
• Assist with reports and collaborate on department goals (15%).
• Complete additional projects as assigned (5%).

Skills

Communication

Analytical

Project Management

Relationship Building

Education

Bachelor's degree in a related field

Tools

MS Office

Job description

Certified Coding Specialist Sr (HCC-Medicare and Medi-Cal)

CalOptima is seeking a highly motivated Certified Coding Specialist Sr (HCC-Medicare and Medi-Cal) to join our team. The role involves managing Hierarchical Condition Categories (HCC) projects and Medi-Cal Annual Wellness Visit initiatives. The incumbent will handle risk adjustment activities to ensure compliance with CMS and DHCS coding guidelines, improve risk scores, and verify medical records using ICD-10-CM guidelines. Travel to physician offices in Orange County may be required.

Position Details:

• Salary Grade: 309 - $68,015 - $108,824
• Work Arrangement: Full Telework (California only)

Responsibilities:

1. Program Support (80%): Conduct audits, assess coding accuracy, develop tools and training, support CMS and DHCS audits, and monitor HCC activities and performance.
2. Administrative Support (15%): Assist with reports, collaborate on department goals, and support audit processes.
3. Other Duties (5%): Complete additional projects as assigned.

Minimum Qualifications:

Bachelor's degree in a related field plus 5 years of risk adjustment coding and audit experience, or equivalent experience. Must have transportation means for off-site work (~20%).

Preferred Qualifications:

RHIT or CRC certification, experience in physician education, presentation skills.

Certifications:

Current CCS or CPC certification from AHIMA or AAPC, maintained during employment.

Knowledge & Skills:

Strong communication, analytical, project management, and relationship-building skills. Proficient in MS Office and relevant systems.

Physical & Work Environment:

Ability to read screens, communicate clearly, and perform manual tasks. Travel and varied environments depending on work location.

About CalOptima:

Orange County’s largest health plan, committed to service, diversity, and community health. Recognized as a top employer with comprehensive benefits including retirement plans, health insurance, and wellness programs.

Application Process:

Applications accepted until filled, with first review on June 26, 2025. Includes assessments, interviews, background check, and medical exam. Apply at our application portal.

CalOptima promotes diversity and equal opportunity employment.