ZipRecruiter

Log In

1

Risk Adjustment Coding Manager Jobs in California

Medix

Risk Adjustment Director

Scotts Valley, CA · On-site

$96.15 - $120.19/hr

... coding, managing financial impacts of risk scores, leading a team, and acting on behalf of the CFO ... Optimize Risk Adjustment Factor improvements through external vendors. * Partner with the Provider ...

previous pagenext page

Showing results 21-40

All JobsRisk Adjustment Coding JobsRisk Adjustment Coding Manager JobsRisk Adjustment Coding Manager Jobs in California

Risk Adjustment Coding Manager information

What are some common challenges faced by risk adjustment coding managers, and how can they effectively address them?

Risk Adjustment Coding Managers often encounter challenges such as ensuring coding accuracy, keeping up with regulatory changes, and coordinating across multidisciplinary teams. To address these, effective managers implement rigorous quality assurance processes, provide ongoing coder education, and maintain open communication with clinical, compliance, and data analytics teams. Staying updated on CMS guidelines and fostering a culture of continuous improvement are also key strategies for success in this role.

What are the key skills and qualifications needed to thrive as a risk adjustment coding manager?

To thrive as a Risk Adjustment Coding Manager, you need expertise in medical coding (CPT, ICD-10), risk adjustment methodologies, and a background in healthcare management, often supported by a coding certification such as CPC, CRC, or CCS. Familiarity with coding software, EHR systems, and data analytics tools is typically required. Strong leadership, attention to detail, and the ability to communicate compliance standards effectively are crucial soft skills. These skills ensure accurate risk adjustment coding, regulatory compliance, and improved financial outcomes for healthcare organizations.

What is the difference between Risk Adjustment Coding Manager vs Risk Adjustment Coder?

AspectRisk Adjustment Coding ManagerRisk Adjustment Coder
CertificationsAHIMA or AAPC credentials, management experienceAHIMA or AAPC credentials, coding certification
Work EnvironmentSupervisory role, overseeing coding teamsPerforming coding tasks directly on patient records
Employer & IndustryHealth plans, healthcare providers, insurance companiesHospitals, clinics, health plans

The Risk Adjustment Coding Manager oversees coding teams and ensures compliance, while the Risk Adjustment Coder focuses on accurately coding patient records. Both roles require similar certifications but differ in responsibilities and work environment, with managers handling supervision and coders performing detailed coding tasks.

What is a risk adjustment coding manager?

Risk Adjustment Coding Managers are professionals responsible for overseeing the medical coding process related to risk adjustment in healthcare organizations. They ensure accurate coding of diagnoses and procedures to reflect the health status of patients, which is essential for proper reimbursement from Medicare Advantage and other insurance plans. These managers lead teams of coders, maintain compliance with regulations, and implement quality assurance processes to optimize coding accuracy and organizational performance.
What are the most commonly searched types of Risk Adjustment Coding jobs in California? The most popular types of Risk Adjustment Coding jobs in California are:
What are popular job titles related to Risk Adjustment Coding Manager jobs in California? For Risk Adjustment Coding Manager jobs in California, the most frequently searched job titles are:
What job categories do people searching Risk Adjustment Coding Manager jobs in California look for? The top searched job categories for Risk Adjustment Coding Manager jobs in California are:
What cities in California are hiring for Risk Adjustment Coding Manager jobs? Cities in California with the most Risk Adjustment Coding Manager job openings:
Risk Adjustment Coding Manager jobs near you
Infographic showing various Risk Adjustment Coding Manager job openings in California as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, 2% Temporary, and 1% Contract. Highlights an 93% Physical, 3% Hybrid, and 4% Remote job distribution.

Risk Adjustment Compliance Coding Specialist, Consultant

Blue Shield of CA

Oakland, CA • On-site

Other

Posted 9 days ago

Job description

Your Role

The Risk Adjustment Compliance Coding Specialist (Consultant) helps to ensure organizational compliance with laws related to Risk Adjustment across our Marketplace (ACA), Medi-Cal (Medicaid), and Medicare Advantage lines of business. Specifically, the role helps to ensure the accuracy, completeness, and integrity of medical coding for risk adjustment programs. This specialist reviews clinical documentation and medical records to verify that all diagnoses and procedures are properly captured and coded in accordance with regulatory standards. By doing so, the specialist helps healthcare organizations meet compliance requirements for federal and state risk adjustment initiatives by supporting appropriate reimbursement, accurate risk stratification, and quality improvement efforts.

Your Knowledge and Experience

  • Requires a bachelor's degree or equivalent experience. A degree in Health Information Management, Nursing, Health Administration, or a related clinical field is preferred
  • Certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent credential is required.
  • Requires a minimum of 6 years of experience in compliance audit, risk adjustment coding, medical coding, compliance auditing, or similar roles in a healthcare setting. Experience with Medicare Advantage, ACA plans, or Medicaid Managed Care is highly preferred
  • Requires deep familiarity with compliance risk assessments and audits
  • Requires direct experience supporting or responding to CMS RADV audits, internal coding compliance audits, or OIG related reviews is strongly preferred.
  • Requires advanced proficiency in ICD-10-CM coding, electronic health record (EHR) systems, coding audit tools, and Microsoft Office Suite (Word, Excel, PowerPoint, Outlook). Experience with risk adjustment analytics software is a plus
  • Requires an in-depth understanding of risk adjustment models (CMS-HCC, HHS-HCC), Official Coding Guidelines, payer policies, and regulatory requirements (CMS, HHS, OIG, DHCS)
  • Requires exceptional analytical and critical thinking abilities, meticulous attention to detail, strong organizational and time management skills, and the capacity to interpret and summarize complex clinical documentation
  • Requires ability to work collaboratively in a team, perform duties with minimal supervision, multi-task, and to deliver a quality work product in a highly regulated, demanding, and constantly changing corporate environment
  • Requires outstanding written and verbal communication skills

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

#LI-CS1

Apply