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Seasonal Hcc Risk Adjustment Coding Jobs in California

Medix

Risk Adjustment Director

Scotts Valley, CA · On-site

$96.15 - $120.19/hr

Expert knowledge of Medicare HCC risk adjustment models. * Working knowledge of CPT, HCPCS, and ICD-9/10 medical coding. * Familiarity with data analytical tools like SQL and visualization platforms ...

UCLA Health

Coding Supervisor

Los Angeles, CA · Remote

$65K - $130K/yr

CPMA (Certified Professional Medical Auditor), CHC (Certified in Healthcare Compliance), HCC (Risk Adjustment Coding Certification) or Specialty Certification * Familiarity with revenue cycle ...

UCLA Health

Coding Supervisor

Los Angeles, CA · On-site

$65K/yr

CPMA (Certified Professional Medical Auditor), CHC (Certified in Healthcare Compliance), HCC (Risk Adjustment Coding Certification) or Specialty Certification * Familiarity with revenue cycle ...

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Seasonal Hcc Risk Adjustment Coding information

What are the most common challenges faced by professionals in seasonal HCC risk adjustment coding roles, and how can they be managed?

Seasonal HCC Risk Adjustment Coders often face the challenge of managing high volumes of medical records within tight deadlines, especially during peak audit or submission periods. Ensuring coding accuracy and compliance with evolving CMS guidelines can also be demanding, as even minor errors may impact reimbursement and risk scores. Staying organized, regularly participating in training updates, and leveraging coding software tools can help manage workloads and maintain accuracy. Collaborating closely with clinical teams and other coders is vital for clarifying documentation and sharing best practices.

What is a seasonal HCC risk adjustment coder?

A Seasonal HCC Risk Adjustment Coder is a healthcare professional who reviews medical records to identify and code diagnoses that impact risk adjustment scores, typically during peak periods such as the Medicare Advantage sweep season. HCC stands for Hierarchical Condition Category, a coding system used by Medicare to predict healthcare costs based on patient diagnoses. These coders ensure accurate documentation, which directly affects insurance reimbursement and compliance. Seasonal roles are common due to the cyclical nature of risk adjustment reporting deadlines.

What is the difference between Seasonal Hcc Risk Adjustment Coding vs Hcc Risk Adjustment Coding?

AspectSeasonal Hcc Risk Adjustment CodingHcc Risk Adjustment Coding
CredentialsCertifications in coding and risk adjustmentCertifications in coding and risk adjustment
Work EnvironmentHealthcare facilities, insurance companies, remoteHealthcare facilities, insurance companies, remote
Industry UsageUsed seasonally for specific risk adjustmentsUsed year-round for ongoing risk management
Search IntentUnderstanding seasonal coding differencesGeneral risk adjustment coding practices

Seasonal Hcc Risk Adjustment Coding focuses on coding practices during specific times of the year, often related to seasonal health trends. In contrast, Hcc Risk Adjustment Coding involves continuous coding to manage patient risk profiles throughout the year. Both roles require similar certifications and work environments but differ mainly in their temporal focus and application.

What are the key skills and qualifications needed to thrive as a seasonal HCC risk adjustment coder?

To thrive as a Seasonal HCC Risk Adjustment Coder, you need a strong understanding of ICD-10-CM coding, risk adjustment methodologies, and a certification such as CPC, CRC, or CCS. Proficiency in coding software, electronic health records (EHRs), and risk adjustment platforms is typically required. Attention to detail, analytical thinking, and strong organizational skills help ensure accuracy and compliance in reviewing medical records. These skills are essential to accurately capture patient risk profiles, support healthcare reimbursement, and maintain regulatory compliance.
What are the most commonly searched types of Hcc Risk Adjustment Coding jobs in California? The most popular types of Hcc Risk Adjustment Coding jobs in California are:
What are popular job titles related to Seasonal Hcc Risk Adjustment Coding jobs in California? For Seasonal Hcc Risk Adjustment Coding jobs in California, the most frequently searched job titles are:
What job categories do people searching Seasonal Hcc Risk Adjustment Coding jobs in California look for? The top searched job categories for Seasonal Hcc Risk Adjustment Coding jobs in California are:
What cities in California are hiring for Seasonal Hcc Risk Adjustment Coding jobs? Cities in California with the most Seasonal Hcc Risk Adjustment Coding job openings:
Seasonal Hcc Risk Adjustment Coding jobs near you
Infographic showing various Seasonal Hcc Risk Adjustment Coding job openings in California as of August 2026, with employment types broken down into 50% Full Time, and 50% Contract. Highlights an 100% Remote job distribution.

Risk Adjustment Compliance Specialist, Principal

Blue Shield of California

Oakland, CA • On-site

$148K - $223K/yr

Full-time

Posted 16 days ago

Blue Shield Of California rating

8.3

Company rating: 8.3 out of 10

Based on 50 frontline employees who took The Breakroom Quiz

127th of 303 rated insurance

Job description


Your Role
The Risk Adjustment Compliance Specialist, Principal is responsible for ensuring organizational compliance with laws related to Risk Adjustment across our Marketplace (ACA), Medicaid and Medicare Advantage lines of business. This role involves auditing, monitoring, and evaluating risk adjustment processes, identifying areas of non-compliance, and recommending corrective actions. The Principal collaborates with internal teams and external partners to maintain the integrity of risk adjustment data and supports the development and implementation of compliance programs.
Responsibilities
Your Work
In this role, you will:
  • Conduct regular audits and reviews of risk adjustment data submissions to ensure compliance with regulatory requirements (e.g., CMS, OIG, HHS).
  • Monitor changes in risk adjustment guidelines, policies, and regulations, and communicate updates to relevant stakeholders.
  • Analyze risk adjustment processes and workflows to identify gaps, inefficiencies, or areas of non-compliance.
  • Prepare reports and presentations summarizing audit findings, compliance risks, and recommendations for improvement.
  • Collaborate with coding, clinical, and data management teams to ensure accurate and complete documentation for risk adjustment purposes.
  • Assist in the development and implementation of training programs related to risk adjustment compliance for staff and providers.
  • Support regulatory reporting and respond to compliance inquiries from internal and external auditors.
  • Maintain documentation of compliance activities and findings in accordance with organizational policies.
  • Participate in Risk Adjustment projects and initiatives, providing compliance expertise and guidance.
  • Strategic thought partner to ensure Risk Adjustment programs are in line with Blue Shield of California strategic goals.
  • Build strategic internal and external relationships that support the goals of the teams.
  • Participate in the development and execution of corrective action plans to address identified compliance issues.
  • Participates in the identification and assessment of potential compliance risks within risk adjustment processes and contributes to mitigation strategies.

Qualifications
Your Knowledge and Experience
  • Requires a college degree or equivalent experience. A degree in health care administration, business, public health, or related field is highly preferred
  • Requires a certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent credential
  • Requires 10 years of relevant experience in Risk Adjustment, Healthcare Compliance, Medical Coding, or related area
  • Requires strong knowledge of ICD-10-CM coding, HCC Risk Adjustment models (CMS-HCC and HHS-HCC), regulatory requirements, RADV audit documentation standards, and compliance standards
  • Requires experience with data analysis, auditing, and reporting in a healthcare environment
  • Requires excellent written and verbal communication skills, with the ability to convey complex information clearly
  • Requires one to be detail-oriented, analytical, and able to manage multiple priorities in a fast-paced setting
  • Requires proficiency in Microsoft Office Suite and relevant healthcare software applications
  • Experience with ACA Marketplace (HHS-HCC) and/or Medi-Cal/Medicaid Managed Care Risk Adjustment programs is highly preferred
  • Certification in Healthcare Compliance (CHC) is preferred
    #LI-CS1

About the Team
About Blue Shield of California
As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!
Our Values:
  • Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
  • Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
  • Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model
We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
  • For most teams, this means coming into the office two days per week.
  • Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
  • For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
Please click here for further physical requirement detail.
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

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