Supervisor – Risk Adjustment (Inland Empire/San Diego)

Description

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence
• Be Innovative
• Work As One Team

What You'll Do

• Supervise, coach, and mentor Risk Adjustment Coding Specialists to ensure high-quality, compliant coding practices
• Serve as a resource for coders regarding ICD-10-CM, HCCs, CMS Risk Adjustment guidelines, and documentation standards
• Monitor individual and team productivity, accuracy, and quality metrics; provide ongoing feedback and corrective action as needed
• Utilize productivity, quality, and audit data to identify performance trends, coding gaps, and training opportunities
• Translate data insights into actionable feedback, performance improvement plans, and targeted education
• Assist with onboarding and training of new coding staff

• Support the Risk Adjustment Manager with day-to-day departmental operations, including workflow coordination, prioritization of audits, and issue resolution
• Assist in developing and maintaining standard operating procedures, workflows, and best practices
• Analyze Risk Adjustment data (e.g., recapture rates, audit findings, productivity, denial trends) to support departmental strategy and prioritization
• Collaborate with leadership to design and implement new or enhanced workflows for coders based on data, performance metrics, and operational needs
• Support reporting and dashboard development to track coding performance, quality outcomes, and Risk Adjustment impact
• Escalate operational, compliance, or performance issues to leadership as appropriate

• Review provider documentation and medical records to ensure all Medicare Advantage and Commercial Risk Adjustment requirements are met
• Perform and/or oversee retrospective and prospective medical record reviews to identify, assess, monitor, and document HCC coding opportunities
• Conduct coding quality audits to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation
• Analyze audit results to identify systemic coding or documentation trends and recommend process improvements
• Prepare audit analyses and provide feedback on noncompliance or documentation improvement opportunities

• Interact with physicians and provider office staff regarding coding, billing, and documentation policies and procedures
• Deliver education and training on Risk Adjustment and documentation improvement, both individually and in group settings
• Assist with the development of educational materials and presentations, including PowerPoint content
• Other duties as assigned

Qualifications

• Travel
  • Reliable transportation and valid driver’s license
  • Ability to travel up to 75% of the time within the designated markets, primarily Houston, with travel to Beaumont and San Antonio as needed. 
• Certifications
  • Certified Coding Specialist (CCS or CCS-P) OR Certified Professional Coder (CPC)
  • Certified Risk Adjustment Coder (CRC) (not required but highly preferred)
• Experience
  • Minimum of 4–5 years of medical coding experience, including Risk Adjustment and HCC coding
  • Prior lead, senior, or supervisory experience
• Skills & Abilities
  • Strong knowledge of Medicare Advantage Risk Adjustment and Hierarchical Condition Categories (HCC)
  • Strong data analysis skills with the ability to interpret coding, audit, and performance metrics
  • Ability to identify patterns and trends within Risk Adjustment data to inform decision-making and workflow design
  • Experience using data to drive operational improvements and support Risk Adjustment initiatives
  • Advanced Excel skills preferred (e.g., pivot tables, reporting, data analysis)
  • Excellent verbal, written, and presentation skills
  • Demonstrated ability to educate and train coding staff and provider office personnel
  • Expert-level proficiency in Microsoft Word, Excel, Outlook, and PowerPoint
  • Strong organizational, analytical, and problem-solving skills

• Have deep expertise in Risk Adjustment and HCC coding
• Are data-driven and comfortable using metrics to guide decisions and improve outcomes
• Enjoy analyzing trends and patterns to enhance Risk Adjustment performance
• Have experience building or refining workflows that improve coder efficiency and accuracy
• Enjoy leading, mentoring, and developing coding professionals
• Thrive in a fast-paced, collaborative environment
• Are detail-oriented and committed to coding accuracy and compliance
• Are comfortable supporting management with operational and workflow needs

Environmental Job Requirements and Working Conditions

• Our organization follows a hybrid work structure where the expectation is to work both onsite and at home on a weekly basis. Up to 75% travel is required in designated market(s).
• The home office of this department is located at 600 City Parkway in Orange. This position will oversee the Inland Empire and San Diego regions.
• The total compensation target pay range for this role is $80,000 - $90,000 per year. The salary range represents our national target range for this role. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.