Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment Hybrid

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n Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment (Hybrid)n

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n General Informationn

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n Work Location: Los Angeles, CA, USAn

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n Onsite or Remoten

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n Flexible Hybridn

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n Work Schedulen

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n Monday -Friday, 7:00am-4:00pm PST, may require occasional weekends or evening hoursn

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n Posted Daten

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n 06/16/2026n

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n Salary Range: $95400 - 208300 Annuallyn

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n Employment Typen

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n 2 - Staff: Careern

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n Durationn

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n Indefiniten

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n Job #n

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n 31257n

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n Primary Duties and Responsibilitiesn

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As the Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment, you will be an expert in risk adjustment coding and documentation, working closely with physicians, IPA coders, and risk adjustment teams associated with the health plan. You will:

• Conduct medical record audits for physicians (MD, DO, or NP) to ensure documentation and coding accuracy of ICD-10 CM codes related to chronic conditions
• Analyze coding patterns within medical groups.
• Provide customized education and updating educational materials for providers and medical groups.
• Participate in additional audit activities for CMS RADV as needed, including retrospective chart reviews.
• Travel to provider offices within Los Angeles area at least three days a week.

UCLA Health salary range for this title code is $95,400-208,300/annually. Please note that the department's target pay range is $95,400 - $120,000/annually.

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n Job Qualificationsn

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

Required:

• A Certified Professional Coder (CPC) certification or Certified Coding Specialist (CCS) certification
• A Certified Risk Adjustment Coder (CRC)
• Reliable transportation to conduct ongoing face-to-face interactions with providers in the Los Angeles area
• Five or more years of experience with physician billing and/or coding
• Three or more years of recent experience in CMS-HCC Risk Adjustment models V24 and V28
• Three or more years of experience in providing education to clinical and non-clinical staff
• Understanding of RADV and audit processes,
• Detailed knowledge and understanding of ICD-10, CPT and CPT (II), and HCPCS coding systems
• Knowledge of Medicare Advantage STARS/HEDIS program and NCQA technical specifications
• Knowledge of HIPAA requirements, anatomy and physiology
• Proficient in MS Word, Excel, PowerPoint and Outlook
• Ability to work effectively with common office software, coding software, and EMR systems
• Bachelorxe2x80x99s degree (healthcare or relevant field) or equivalent experience/training

Preferred:

• Six or more years of clinic or IPA and/or managed care experience
• Knowledge of Medicare Advantage billing/claims submission and other related actions
• Ability to work effectively with common office software, coding software, and EMR systems
• Registered Nurse (RN) or clinical qualifications

Note: Skills may be subject to test.

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As a condition of employment, the final candidate who accepts an offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; or have filed an appeal of a finding of substantiated misconduct with a previous employer.

Current/former UC employees are subject to a personnel file review.

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