Risk Adjustment Program Manager & Coding Quality Lead

Altais Health Solutions; Oakland (CA); On-site; USD 107,000 - 129,000; Full time

Benefits offered by this job

Medical insurance

Vision insurance

Dental coverage

401k with company match

Flexible time off

Job summary

Altais Health Solutions in Oakland, CA, seeks a Manager, Risk Adjustment Program to lead a team of risk adjustment coders and oversee internal audits, ensuring compliance with CMS, AMA, and payer standards. You will drive education, QA programs, and vendor performance while advancing accurate HCC recapture.

A strong coding background, 7+ years of related experience with 3+ years in a lead role, and coding credentialing are required.

Qualifications

• Bachelor’s Degree or equivalent experience in coding and documentation for Risk Adjustment programs.
• 7 years related experience including 3-5 years of professional coding experience.
• 3 years’ experience in a lead role.
• Experience implementing risk adjustment coding compliance rules and regulations.
• Successful completion of Coding Certificate program from an accredited organization (CPC/CRC/CPMA or CCS/CCS-P) is required.

Responsibilities

• Provide oversight and leadership to a team of internal risk adjustment coders and contract staff.
• Hire and manage performance of staff; conduct coder audits regularly per compliance.
• Conduct internal audits of medical record documentation supporting HCC and retrospective coding.
• Pre-audit CMS RADV requests and health plan compliance audits; ensure codes are supported.
• Evaluate diagnoses coded from Risk Adjustment programs for guideline adherence.
• Deliver education and coding training for clinicians and coders to ensure compliance.
• Prepare formal audit reports and present findings to leadership; respond to questions from staff.
• Develop educational programs based on audit findings and expand coding documentation knowledge.
• Perform follow-up reviews to determine additional education needs and monitor improvement.
• Communicate with senior leadership; collaborate on joint projects and vendor oversight related to risk adjustment.

Skills

Leadership

Team management

Risk adjustment knowledge

Education

Bachelor’s degree or equivalent

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

Job description

Altais Health Solutions in Oakland, CA, seeks a Manager, Risk Adjustment Program to lead a team of risk adjustment coders and oversee internal audits, ensuring compliance with CMS, AMA, and payer standards. You will drive education, QA programs, and vendor performance while advancing accurate HCC recapture.

A strong coding background, 7+ years of related experience with 3+ years in a lead role, and coding credentialing are required.