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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 ...

NORTHEAST COMMUNITY CLINIC

HCC Coder

Alhambra, CA

$34 - $39/hr

Attend weekly meetings and present HCC Risk Adjustment Coding Department feedback, including data ... Other duties as assigned by the Billing Manager, Medical Director, Finance Director, or Executive ...

NORTHEAST COMMUNITY CLINIC

HCC Coder

Alhambra, CA · On-site

$34 - $39/hr

Attend weekly meetings and present HCC Risk Adjustment Coding Department feedback, including data ... Other duties as assigned by the Billing Manager, Medical Director, Finance Director, or Executive ...

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Risk Adjustment Coding Manager information

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 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 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 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 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 Coding Specialist II (CST/EST)

Astrana Health, Inc.

Monterey Park, CA • Remote

$70K - $85K/yr

Full-time

Posted 7 days ago

Job description

Description
We are currently seeking a highly motivated Risk Adjustment Coding Specialist to support our Houston market.  In this role, you will support risk adjustment efforts by conducting high-volume chart reviews to identify coding gaps, trends, and opportunities for improved accuracy for our providers. You’ll translate your findings into actionable insights, creating and delivering education to providers and practice leaders while navigating complex conversations. Additionally, you’ll track and report on key performance metrics—such as HCC recapture rates, AWVs, and other KPIs, helping drive provider performance and overall program success. 
We are seeking candidates who have experience with provider education and at least 3-5 years of risk adjustment experience! This position requires travel to provider offices twice a week in the Houston area.
Our Values: 
  • Put Patients First
  • Empower Entrepreneurial Provider and Care Teams
  • Operate with Integrity & Excellence
  • Be Innovative
  • Work As One Team

What You'll Do
  • Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company
  • Review medical record information on both a retroactive and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC) 
  • Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10- CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines 
  • Interacts with physicians regarding coding, billing, documentation policies, procedures, and conflicting/ambiguous or non-specific documentation
  • Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing
  • Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes, Stay informed about changes in Medicare, Medicaid, and private payer requirements.
  • Provides recommendations to management related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives.
  • Trains, mentors and supports new employees during the orientation process. Functions as a resource to existing staff for projects and daily work.
  • Provides peer to peer guidance through informal discussion and overread assignments. Supports coder training and orientation as requested by manager.
  • May assist or lead projects and/or higher work volume than Risk Adjustment Coding Specialist I
  • Other duties as assigned

Qualifications
  • Required Certification/Licensure: Must possess and maintain AAPC certification, CPC and CRC.
  • At least 3 years of experience in risk adjustment coding and/or billing experience required.
  • At least 1 year of experience with targeted provider education.
  • Reliable transportation/Valid Driver’s License/Must be able to travel up to 75% of work time
  • PC skills and experience using Microsoft applications such as Word, Excel, and Outlook
  • Excellent presentation, verbal and written communication skills, and ability to collaborate 
  • Must possess the ability to educate and train provider office staff members
  • Proficiency with healthcare coding software and Electronic Health Records (EHR) systems.
You're great for this role if:    
  • Strong billing knowledge and/or Certified Professional Biller (CPB) through APPC
  • Have knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage
  • Strong PowerPoint and public speaking experience
  • Ability to work independently and collaborate in a team setting
  • Experience with Monday.com
  • Experience collaborating with, educating, and presenting to provider teams in a face-to-face setting

Environmental Job Requirements and Working Conditions
  • The national target pay range for this role is $70,000 - $85,000 per year. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
  • This position is remotely based in the U.S. The home office is located at 1600 Corporate Center Dr. Monterey Park, CA 91754. 
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.    

Additional Information:     
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.