We are seeking a proactive, highly organized, detail-oriented individual with:

• A Certified Professional Coder (CPC) certification or Certified Coding Specialist (CCS) certification, required
• A Certified Risk Adjustment Coder (CRC), required
• Reliable transportation to conduct ongoing face-to-face interactions with providers in the Los Angeles area, required
• Five or more years of experience with physician billing and/or coding, required
• Three or more years of recent experience in CMS-HCC Risk Adjustment models V24 and V28, required
• Three or more years of experience in providing education to clinical and non-clinical staff, required
• Understanding of RADV and audit processes, required
• Detailed knowledge and understanding of ICD-10, CPT and CPT (II), and HCPCS coding systems required
• Knowledge of Medicare Advantage STARS/HEDIS program and NCQA technical specifications, required
• Six or more years of clinic or IPA and/or managed care experience, preferred
• Knowledge of Medicare Advantage billing/claims submission and other related actions, preferred
• Knowledge of HIPAA requirements, anatomy and physiology, required
• Proficient in MS Word, Excel, PowerPoint and Outlook, required
• Ability to work effectively with common office software, coding software, and EMR systems, required
• Registered Nurse (RN) or clinical qualifications a plus
• Bachelor’s degree (healthcare or relevant field) or equivalent experience/training

Note: Skills may be subject to test.