Risk Adjustment Provider Engagement Lead

Alignment Health

Risk Adjustment Provider Engagement Lead responsible for coding accuracy and provider education in healthcare. Validating documentation and collaborating with medical teams to enhance coding outcomes.

Posted 5/14/2026full-timeRemote • California • 🇺🇸 United StatesSenior💰 $70,823 - $106,234 per yearWebsite

About the role

Key responsibilities & impact

Validates provider documentation for accuracy by reviewing and analyzing samples of coding and claims extracts compared to actual medical records
Develops education materials to assist physicians in accurately assessing patients’ overall health status
Provides feedback to providers on performance improvement opportunities; tracks and prioritizes projects to improve coding and documentation outcomes
Maintains a comprehensive tracking and management tool for assigned physicians within Alignments Healthcare provider network
Identifies issues, determines impact to risk adjustment models, and reports results timely to ensure that physicians remain in compliance
Collect, analyze, and share MRA performance data through clear presentations and detailed reports, including outreach priorities, HCC gap data, and encounter status insights for use through Joint Working Groups (JWGs) with internal and external stakeholders
Collaborate with internal and external coding, analytics, and clinical teams to ensure accurate and complete diagnosis coding and HCC Gap Closures
Presents progress and results to leadership on a routine basis
Assists with CMS Risk Adjustment Data Validation activities to ensure our external physicians and Alignment Healthcare is prepared for and will pass an audit
Regularly updates all Risk Adjustment materials with clinical and/or official guideline changes
Suggests, updates, and enhances clinical educational materials to assist in training physicians and clinical staff on Risk Adjustment Healthcare Programs including CMS-HCC Models, Clinician Chart Reviews, and Encounter Documentation
Suggests customizations of Risk Adjustment education for various audiences; Support Staff, PCPs, Specialists, Employees vs. contracted and Central Departments
Stays current on industry coding, compliance and HCC issues
Utilizes, protects, and discloses Alignment Healthcare patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies

Requirements

What you’ll need

Three-five years of coding in a medical group or health plan setting required
Professional Coding experience required
Experience with strategic planning in risk mitigation
Proficiency in MS Office suite including Access
Previous use of Epic, Allscripts, EZCap a plus
Bachelor’s degree in business administration, health care management or a related field or equivalent experience
Current driver’s license
CPC, CPC-H, CCS, CCS-P, RHIT, RHIA, OR CPMA

Benefits

Comp & perks

Local travel is required

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

codingclaims analysisrisk adjustmentdata validationdiagnosis codingHCC gap closurestrategic planningdata analysispresentation skillseducational material development

Soft Skills

collaborationfeedback provisionproject managementcommunicationtrainingproblem-solvingattention to detailorganizational skillsleadershipnetworking

Certifications

CPCCPC-HCCSCCS-PRHITRHIACPMA