Senior Encounter Data & Coding Specialist - Medicare Risk

Elders; Oakland (CA); On-site; USD 96,000 - 145,000; Full time

Job summary

Center for Elders’ Independence in Oakland, CA, seeks a Senior Encounter Data & Coding Specialist to ensure complete, accurate, and compliant encounter data, ICD-10-CM coding, and regulatory reporting for CMS, Medicare, Medicaid, and PACE. This senior role collaborates with clinical staff, HIM, IT, and providers to resolve data discrepancies and support revenue integrity and risk adjustment initiatives.

The annual pay range is $95,721 to $145,496 USD, with placement based on experience and

Qualifications

• Bachelor's degree in Health Information Management, Healthcare Administration, Nursing, Business Administration, or related field preferred.
• Minimum five years of healthcare experience in encounter data, coding, revenue cycle, risk adjustment, or HIM with progressive responsibilities.
• Minimum three years in PACE, Medicare Advantage, managed care, risk adjustment, or encounter data; direct PACE preferred.
• Experience investigating encounter submission errors and performing reconciliation activities.
• Certified CPC/CRC/CCS/RHIT/RHIA preferred; CPC or CRC strongly preferred.
• Knowledge of ICD-10-CM coding guidelines and CMS regulations.

Responsibilities

• Review, validate, monitor, and reconcile encounter data submissions.
• Investigate encounter rejections, edits, denials, and discrepancies.
• Correct and resubmit encounter records as needed.
• Perform reconciliation between EHR, billing, and CMS reports.
• Develop data quality controls and conduct coding reviews.
• Collaborate with providers and clinical staff to improve documentation.
• Prepare reports for Revenue Cycle, Finance, Compliance, and Leadership.

Skills

ICD-10-CM coding

CMS Encounter Data

Regulatory compliance

Data reconciliation

Microsoft Excel

SQL

Power BI

Analytical skills

Communication skills

Problem solving

Education

Bachelor's degree

Tools

Electronic Health Records (EHR)

Job description

Center for Elders’ Independence in Oakland, CA, seeks a Senior Encounter Data & Coding Specialist to ensure complete, accurate, and compliant encounter data, ICD-10-CM coding, and regulatory reporting for CMS, Medicare, Medicaid, and PACE. This senior role collaborates with clinical staff, HIM, IT, and providers to resolve data discrepancies and support revenue integrity and risk adjustment initiatives.

The annual pay range is $95,721 to $145,496 USD, with placement based on experience and