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Senior Hcc Risk Adjustment Coder Jobs in California

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 ...

Astiva Health

Healthcare Data Analyst

Orange, CA · On-site

$85K - $115K/yr

Knowledge of HCC risk adjustment, RAF methodologies, capitation payment model, DOFR, claim processing, bid design, and CMS regulatory requirements. * Experience analyzing pharmacy adherence metrics ...

Astiva Health

Healthcare Data Analyst

Orange, CA

$85K - $115K/yr

Knowledge of HCC risk adjustment, RAF methodologies, capitation payment model, DOFR, claim processing, bid design, and CMS regulatory requirements. * Experience analyzing pharmacy adherence metrics ...

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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Senior Hcc Risk Adjustment Coder information

What does a Senior HCC Risk Adjustment Coder do?

A Senior HCC Risk Adjustment Coder reviews medical records and assigns appropriate ICD-10 codes to ensure accurate risk adjustment for healthcare organizations. Their work supports proper reimbursement and compliance by identifying and coding Hierarchical Condition Categories (HCCs) based on clinical documentation. Senior coders typically have advanced knowledge of coding guidelines, risk adjustment models, and relevant regulations such as Medicare Advantage requirements. They may also audit coding work, provide training, and help implement best practices within their teams.

What are some common challenges faced by Senior HCC Risk Adjustment Coders, and how can they be addressed?

Senior HCC Risk Adjustment Coders often encounter challenges such as keeping up with frequent coding guideline updates, navigating complex electronic health record systems, and ensuring accurate documentation to support risk adjustment scores. To address these, staying current with industry training and certification requirements is essential, as is developing strong communication skills to collaborate effectively with providers and other coding professionals. Regular auditing and feedback can also help maintain high accuracy and compliance, contributing to both individual and team success.

What are the key skills and qualifications needed to thrive as a Senior HCC Risk Adjustment Coder?

To thrive as a Senior HCC Risk Adjustment Coder, you need in-depth knowledge of ICD-10-CM coding, risk adjustment methodologies, and a relevant credential such as CPC, CRC, or CCS. Familiarity with coding software, EHR systems, and risk adjustment analytics platforms is essential. Attention to detail, analytical thinking, and strong communication skills distinguish top performers in this role. These skills ensure accurate documentation and coding, directly impacting healthcare organizations' compliance and financial outcomes.
What are the most commonly searched types of Hcc Risk Adjustment Coder jobs in California? The most popular types of Hcc Risk Adjustment Coder jobs in California are:
What cities in California are hiring for Senior Hcc Risk Adjustment Coder jobs? Cities in California with the most Senior Hcc Risk Adjustment Coder job openings:
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BILLING SUPERVISOR II

North East Medical Services

Daly City, CA • On-site

$112K - $128K/yr

Full-time

Re-posted 9 days ago

Job description

The Billing Supervisor II (Front-End Revenue) is the senior supervisory role within the Billing department and supports the Revenue Cycle Manager in leading the front-end revenue cycle to achieve organizational goals. This role directly supervises the medical coding function (Medical Coder and Senior Medical Coder), the provider enrollment and credentialing function (Provider Enrollment Specialist and Senior Provider Enrollment Specialist), and front-end charge-review and claims staff. The position is accountable for charge capture integrity, accurate code assignment, clean-claim submission, and front-end denial prevention, ensuring work entering the revenue cycle is complete, compliant, and timely so as to enhance revenue, accelerate cash flow, and reduce claim denials. The Billing Supervisor II leads evaluation and training of front-end staff, partners with the Billing Supervisor I (Back-End Revenue) to coordinate hand-offs across the revenue cycle, and works with operational, clinical, and EHR departments to drive process improvements, set priorities, and develop innovative solutions. The Billing Supervisor II ranks above Billing Supervisor I; both report to the Revenue Cycle Manager.
ESSENTIAL JOB FUNCTIONS:
  • Demonstrates a thorough and authoritative understanding of Medicare, Medi-Cal, FQHC (Federally Qualified Health Center), state, local programs, and private insurance regulations, and serves as the front-end subject-matter resource.
  • Directly supervises the medical coding function: coordinates and monitors the work of the Medical Coder and Senior Medical Coder, ensures coding and documentation comply with ICD-10, CPT, HCPCS, HCC risk adjustment, and CMS NCD/LCD guidelines, and supports timely resolution of coding-related and medical-necessity claim edits.
  • Directly supervises the provider enrollment and credentialing function: coordinates and monitors the work of the Provider Enrollment Specialist and Senior Provider Enrollment Specialist, and ensures timely and compliant enrollment, re-credentialing, revalidation, CAQH attestations, and SB 137 provider-data maintenance to prevent enrollment-driven billing disruptions.
  • Directs charge review and claim-edit work: oversees front-end claim scrubbing, charge capture validation, and resolution of pre-submission edits to maximize clean-claim rates.
  • Provides direction, monitoring, training, and assistance to front-end team members; establishes priorities, assigns and balances workloads, inspects completed work, and resolves escalated front-end issues.
  • Conducts probationary and annual evaluations for front-end staff (coding, provider enrollment, charge/claims); for senior specialist roles, evaluations are completed in consultation with the Revenue Cycle Manager and informed by compliance metrics, productivity data, and technical input from subject-matter resources.
  • Partners with the Billing Supervisor I (Back-End Revenue) to coordinate clean hand-offs between front-end submission and back-end posting, follow-up, and AR.
  • Uses the Epic Professional Billing and Claims environment for charge, code, and claims-library awareness, and coordinates with the Epic Analyst (who owns system configuration) to report, validate, and resolve front-end application issues.
  • Monitors front-end denial trends, identifies root causes, and implements process improvements; develops policies and procedures and ensures consistent adoption across the front-end functions.
  • Designs and delivers training for new and existing front-end employees on coding, enrollment, charge review, and claims software and workflows.
  • Generates and reviews front-end performance reports (coding accuracy, enrollment status, clean-claim and edit rates) for the Revenue Cycle Manager and Administration.
  • Performs additional duties as assigned by management.

  • Completion of a four-year degree from an accredited university.
  • Must hold at least one Epic Resolute Professional Billing (PB) certification. Epic Resolute Claims and Remittance certification is preferred.
  • Minimum of three years of supervisory experience in a healthcare revenue cycle, billing, coding, or provider enrollment setting, including experience leading or developing staff.
  • At least five years of professional experience in healthcare revenue cycle operations in a complex healthcare or FQHC setting, with front-end (coding, enrollment, charge/claims) exposure.
  • Working knowledge of medical coding (ICD-10, CPT, HCPCS, HCC risk adjustment) and provider enrollment / credentialing processes (CAQH, SB 137, payer revalidation) sufficient to supervise these functions; coding credential (AAPC/AHIMA) or equivalent experience preferred.
  • Excellent analytical and communication skills, with the ability to convey complex information clearly to technical and non-technical audiences.
  • Proficient in computer skills, including billing/coding software and Microsoft Office applications.
  • Ability to write clear and professional business correspondence, policies, and procedures.
  • Strong organizational skills, with the ability to manage and coordinate multiple front-end processes and personnel simultaneously.
  • Committed to maintaining high standards of customer service in a demanding and complex healthcare environment.
  • Demonstrates initiative, resourcefulness, integrity, and timeliness to achieve high levels of customer satisfaction.
  • Self-motivated, diligent, organized, resourceful, responsible, and enthusiastic in all aspects of work.

LANGUAGE:
  • Must be able to fluently speak, read and write English.
  • Fluent in Chinese (Cantonese and/or Mandarin) preferred.
  • Fluency in other languages is an asset.

STATUS:
This is an FLSA Exempt position.
This is not an OSHA high-risk position.

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