Senior Encounter Data & Coding Strategist

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

Job summary

Center for Elders’ Independence in Oakland, CA is seeking a Senior Encounter Data & Coding Specialist to ensure completeness, accuracy, and regulatory compliance of encounter data, diagnosis coding, and CMS reporting for CMS, Medicare, Medicaid, and PACE.

The role combines encounter oversight, coding validation, error resolution, reconciliation, and clinical documentation improvement, collaborating with clinical staff, HIM, IT, and providers to improve documentation quality and revenue integrity.

Qualifications

• Bachelor’s degree preferred in HIM, healthcare administration, or related field.
• Minimum five years in encounter data, coding, revenue cycle, or HIM with progressive responsibility.
• Minimum three years in PACE, Medicare Advantage, or encounter data; direct PACE experience preferred.
• Experience investigating encounter submission errors and performing reconciliations.
• Certifications such as CPC/CRC/CCS/RHIT/RHIA preferred; CPC/CRC strongly preferred.
• Strong knowledge of ICD-10-CM guidelines and CMS requirements.
• Advanced Excel, SQL, Power BI or healthcare analytics tools.
• Excellent analytical, organizational, and problem-solving skills.
• Strong written and verbal communication skills.

Responsibilities

• Review and reconcile encounter data submissions.
• Investigate rejections, edits, denials, and discrepancies.
• Correct and resubmit encounter records as needed.
• Perform encounter reconciliation across EHR, billing, and CMS reports.
• Monitor submission rates and identify trends with corrective actions.
• Develop and maintain encounter data quality controls.
• Conduct concurrent and retrospective coding reviews.
• Assign and validate ICD-10-CM codes based on documentation.
• Ensure complete capture of chronic conditions and risk-adjusting diagnoses.
• Identify documentation deficiencies and query providers as appropriate.
• Collaborate with providers to improve documentation quality.
• Serve as primary resource for encounter error investigation and resolution.
• Analyze CMS reports to identify root causes of errors.
• Create corrective action plans and dashboards for performance metrics.
• Prepare reports for Revenue Cycle, Finance, Compliance, and Leadership.
• Support Medicare risk adjustment capture and annual diagnosis review.

Skills

Encounter data validation

Coding review

Risk adjustment

CMS reporting

Data reconciliation

SQL

Excel

Power BI

Communication skills

Analytical thinking

Education

Bachelor’s degree in Health Information Management (HIM)

Bachelor’s degree in Healthcare Administration or related field

Tools

SQL

Power BI

Excel

Job description

Center for Elders’ Independence in Oakland, CA is seeking a Senior Encounter Data & Coding Specialist to ensure completeness, accuracy, and regulatory compliance of encounter data, diagnosis coding, and CMS reporting for CMS, Medicare, Medicaid, and PACE.

The role combines encounter oversight, coding validation, error resolution, reconciliation, and clinical documentation improvement, collaborating with clinical staff, HIM, IT, and providers to improve documentation quality and revenue integrity.