Hybrid: Senior Risk Adjustment Operations Lead

Paycom; Huntington Beach (CA); Hybrid; USD 82,000 - 100,000; Full time

Job summary

Clever Care Health Plan is seeking a Senior Risk Adjustment Operations Specialist in Huntington Beach. The role facilitates communication between coding teams and PCP practices, translating findings into actionable provider education and workflow improvements.

You will analyze risk adjustment data, support documentation improvement, and coordinate with multiple stakeholders to ensure compliant coding and successful RADV readiness. Hybrid schedule with onsite attendance required.

Qualifications

• Bachelor’s degree in healthcare administration, health information management, nursing, business, or equivalent experience.
• Five+ years in Medicare Advantage risk adjustment or related field.
• Current professional coding credential preferred (CPC/CCS/CCS-P/CRC/RHIA/RHIT).
• Knowledge of ICD-10-CM, CMS-HCC risk adjustment, and compliant provider education.
• Experience collaborating with physicians and provider staff.
• Proficiency with Microsoft Office and EHRs.

Responsibilities

• Serve as the primary operational liaison between coding teams and PCP practices.
• Deliver provider education on compliant HCC documentation and MEAT principles.
• Translate coder feedback into provider-facing guidance and track issues.
• Identify documentation gaps and recommend practical workflow improvements.
• Analyze risk adjustment data to guide outreach and training.
• Support audits, compliance reviews, and CMS RADV readiness.

Skills

Facilitation

Communication

Data interpretation

Project management

Education

Bachelor's degree in healthcare administration or related field

Tools

Microsoft Office

EHR systems

Reporting platforms

Job description

Clever Care Health Plan is seeking a Senior Risk Adjustment Operations Specialist in Huntington Beach. The role facilitates communication between coding teams and PCP practices, translating findings into actionable provider education and workflow improvements.

You will analyze risk adjustment data, support documentation improvement, and coordinate with multiple stakeholders to ensure compliant coding and successful RADV readiness. Hybrid schedule with onsite attendance required.