Risk Adjustment Program Manager - Coding & QA Lead

Altais; California; On-site; USD 107,000 - 129,000; Full time

Benefits offered by this job

Excellent medical, vision, and dental

401k with company match

Flexible time off & 9 paid holidays

Job summary

Altais is seeking a Manager, Risk Adjustment Program to lead a team of risk adjustment coders and oversee audits of documentation and coding to ensure CMS and health plan compliance. You will manage staff, perform detailed coder audits, and drive education initiatives for clinicians and coders.

Ideal candidates hold a CPC/CRC/CPMA or CCS/CCS-P, a bachelor’s degree, and 3–5 years in a lead role, with 7+ years in risk adjustment coding.

Qualifications

• Bachelor’s degree or equivalent in coding/ddocumentation for Risk Adjustment programs.
• 7+ years related experience, including 3–5 years in a lead role.
• Experience implementing risk adjustment coding compliance rules and regulations.

Responsibilities

• Provide oversight and leadership to internal risk adjustment coders and contract staff.
• Hire and manage performance of staff.
• Perform coder audits and identify education needs.
• Conduct internal audits of medical record documentation for HCC recapture and coding accuracy.
• Educate clinicians and coders on coding guidelines and compliance with AHA/AMA/CMS standards.
• Prepare audit reports and present to leadership.
• Respond to questions from physicians, managers, coders, and staff regarding billing and documentation.

Skills

Leadership

Coding experience

Regulatory compliance

Auditing

Training & education

Education

Bachelor’s degree or equivalent

Coding certificate (CPC/CRC/CPMA or CCS/CCS-P)

Job description

Altais is seeking a Manager, Risk Adjustment Program to lead a team of risk adjustment coders and oversee audits of documentation and coding to ensure CMS and health plan compliance. You will manage staff, perform detailed coder audits, and drive education initiatives for clinicians and coders.

Ideal candidates hold a CPC/CRC/CPMA or CCS/CCS-P, a bachelor’s degree, and 3–5 years in a lead role, with 7+ years in risk adjustment coding.