Strategic Senior Encounter Data & Coding Lead

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

Job summary

Center for Elders' Independence seeks a Senior Encounter Data & Coding Specialist to ensure completeness, accuracy, and regulatory compliance of encounter data, ICD-10-CM coding, and clinical documentation for CMS, Medicare, Medicaid, and PACE reporting.

This senior professional collaborates with clinicians, HIM, and IT to resolve discrepancies, support revenue integrity and risk adjustment, and maintain dashboards while preparing leadership reports.

Qualifications

• Bachelor's degree preferred in a related field.
• Minimum five years healthcare experience spanning encounter data, medical coding, revenue cycle, risk adjustment, or Health Information Management.
• Minimum three years of experience with PACE, Medicare Advantage, managed care, risk adjustment, or encounter data; direct PACE experience preferred.
• Experience investigating encounter submission errors and performing reconciliation activities.
• Certifications preferred (CPC, CRC, CCS, RHIT, RHIA); CPC/CRC strongly preferred.
• Knowledge of ICD-10-CM coding guidelines and Medicare risk-adjustment methodologies.
• Proficiency with Excel, SQL, Power BI, and healthcare analytics tools.

Responsibilities

• Review, validate, monitor, and reconcile encounter data submissions.
• Investigate rejections, edits, denials, and discrepancies.
• Correct and resubmit encounter records as needed.
• Perform reconciliation between EHRs, billing, claims, and CMS reports.
• Develop data quality controls and conduct coding reviews.
• Assign and validate ICD-10-CM codes based on documentation.
• Identify documentation deficiencies and initiate provider queries.
• Collaborate with clinical staff to improve documentation quality.
• Prepare reports for Revenue Cycle, Finance, Compliance, and Leadership.

Skills

Analytical

Attention to detail

Regulatory compliance

Communication skills

Education

Bachelor's degree (Health Information Management, Healthcare Administration, Nursing, Business Administration, or related)

Tools

Microsoft Excel (Advanced)

SQL

Power BI

Healthcare analytics tools

Job description

Center for Elders' Independence seeks a Senior Encounter Data & Coding Specialist to ensure completeness, accuracy, and regulatory compliance of encounter data, ICD-10-CM coding, and clinical documentation for CMS, Medicare, Medicaid, and PACE reporting.

This senior professional collaborates with clinicians, HIM, and IT to resolve discrepancies, support revenue integrity and risk adjustment, and maintain dashboards while preparing leadership reports.