Clinical Documentation Integrity Specialist – Medicare Advantage Risk Adjustment

UCLA Health

Clinical Documentation Integrity Specialist ensuring accurate coding and documentation for Medicare Advantage. Conducting audits and providing education while traveling to provider offices in the Los Angeles area.

Posted 7/27/2026full-timeLos Angeles • California • 🇺🇸 United StatesMid-LevelSenior💰 $100,161 - $218,718 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical record audits, coding accuracy, and education for healthcare providers, with a strong focus on ICD-10 CM codes and CMS-HCC Risk Adjustment models. Proficient in utilizing coding systems and software to ensure compliance and enhance documentation practices.

Highest-signal resume keywords

Certified Professional Coder (CPC)Certified Risk Adjustment Coder (CRC)Five Years Experience in Physician Billing and CodingDetailed Knowledge of ICD-10, CPT, and HCPCS Coding SystemsUnderstanding of RADV and Audit Processes

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

ICD-10 CM CodingCPT CodingHCPCS CodingCMS-HCC Risk Adjustment Models V24 and V28Medical Record AuditsCoding Pattern AnalysisEducation and Training for Clinical StaffMedicare Advantage STARS/HEDIS KnowledgeHIPAA ComplianceAnatomy and Physiology Knowledge

Soft Skills

Effective CommunicationInterpersonal SkillsDetail-OrientedOrganizational SkillsAbility to Work Independently

Tools & Technologies

MS WordMS ExcelMS PowerPointMS OutlookEMR SystemsCoding Software

Certifications & Qualifications

Certified Professional Coder (CPC)Certified Coding Specialist (CCS)Certified Risk Adjustment Coder (CRC)

Industry Keywords

Medical Record AuditsCMS RADVRisk Adjustment CodingHealthcare ComplianceProvider Education

About the role

Key responsibilities & impact

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.

Requirements

What you’ll need

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
Bachelor’s degree (healthcare or relevant field) or equivalent experience/training

Benefits

Comp & perks

Flexible Hybrid
Occasional weekends or evening hours
Employee Resources
Employee Referral Program
Employee Onboarding