Hybrid Senior Risk Adjustment Operations & Education Lead

Clever Care Health Plan; Huntington Beach (CA); Ibrido; USD 82.000 - 100.000; Tempo pieno

Descrizione del lavoro

Clever Care Health Plan in Huntington Beach, CA is seeking a Senior Risk Adjustment Operations Specialist to improve HCC capture, documentation specificity, and coding accuracy. This hybrid role involves coordinating with risk adjustment coders, PCP practices, and internal teams to drive education and sustainable workflows.

The role requires deep knowledge of ICD-10-CM, CMS-HCC, and compliant provider education, with a track record of improving documentation and recapture while supporting audits

Competenze

• Bachelor’s degree or equivalent experience in healthcare field.
• 5+ years in Medicare Advantage risk adjustment or related area.
• Current coding credential such as CPC/CCS preferred; CRC or similar risk adjustment credential preferred.
• Strong knowledge of ICD-10-CM coding, CMS-HCC requirements, and compliant education.

Mansioni

• Act as liaison between coding teams and PCP practices to improve documentation.
• Deliver provider education on HCC documentation, MEAT principles, and requirements.
• Translate coder feedback into provider-facing guidance and track resolutions.
• Identify documentation gaps and recommend workflow or template improvements.
• Prioritize provider outreach using risk adjustment reports and coding trends.
• Support audits, compliance reviews, and CMS RADV readiness activities.
• Collaborate across Risk Adjustment, Quality/Stars, IT, and vendor partners.
• Develop standard work, training materials, and job aids for providers.

Conoscenze

ICD-10-CM expertise

CMS-HCC risk adjustment

Provider education

Relationship management

Verbal/written communication

Data analysis

Formazione

Bachelor’s degree in healthcare administration or related field

Equivalent relevant experience considered

Strumenti

Microsoft Office

Electronic Health Record systems

Reporting platforms

Descrizione del lavoro

Clever Care Health Plan in Huntington Beach, CA is seeking a Senior Risk Adjustment Operations Specialist to improve HCC capture, documentation specificity, and coding accuracy. This hybrid role involves coordinating with risk adjustment coders, PCP practices, and internal teams to drive education and sustainable workflows.

The role requires deep knowledge of ICD-10-CM, CMS-HCC, and compliant provider education, with a track record of improving documentation and recapture while supporting audits