Manager, Risk Coding

Date: Nov 17, 2022

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 8249 


Position Summary/Position


Under the direction of the Director of Actuarial Services - Risk Analytics, the Manager of Risk Coding will manage, oversee, and monitor the process and workflows of coding for risk adjustment models for Medi-Cal and Covered CA products. This manger will interact with Compliance, Quality, and other business units to ensure quality and consistency of ICD-10 coding and documentation guidance in accordance with regulatory requirements. This manager will also direct and educate a team of coding specialists to support the work assigned to the team.   

Major Functions (Duties and Responsibilities)


1. Provide leadership/mentorship to the team of coding specialists on day-to-day risk adjustment activities and/or assignments for Medi-Cal and Covered CA products
2. Oversee development and execution of processes that will support complete and accurate diagnosis coding and risk score accuracy
3. Responsible for day-to-day operations of risk adjustment vendor management for retrospective and/or prospective initiatives 
4. Collaborate with the Actuarial Manager to monitor risk adjustment initiative performance outcomes
5. Act as a RADV liaison with other internal business units and external partners
6. Remain current on diagnosis coding guidelines and risk adjustment reimbursement reporting requirements
7. Comply with the Standards of Ethical Coding as set forth by American Health Information Management Associate (AHIMA) and adhere to official coding guidelines 
8. Comply with HIPPA laws and regulations
9. Demonstrate a commitment to incorporate LEAN principles into daily work.

Major Functions (Duties and Responsibilities) Cont

Supervisory Responsibilities

Leader: Administers Hires, Terminations, and Performance Reviews

Experience Qualifications


Five (5) years of experience with risk adjustment and/or STARS/HEDIS coding. Three (3) years of management experience. 

Preferred Experience

Education Qualifications


Bachelor’s degree in Nursing, Healthcare Administration, or related field from an accredited institution required.

Preferred Education

Professional Certification


AHIMA or AAPC Certified Coder required. 

CRC certification preferred.

Professional Licenses

Drivers License Required

Yes, must have a valid California Driver's license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points.

Knowledge Requirement


Working knowledge of HCC coding requirements, ICD-10 and CPT guidelines are required. Must have expert fluency and proficiency with CMS risk adjustment methodology and HCC terminology. Knowledge in risk adjustment models for Covered CA or Medi-Cal is preferred.

Skills Requirement


Excellent written, oral, and presentation skills is required.  Proficiency in Microsoft Word, Excel, PowerPoint.   

Abilities Requirement


Ability to take general direction and manage complex projects within deadlines.  Attention to details and the ability to organize and prioritize is required. 

Commitment to Team Culture


The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions


Position is eligible for telecommuting/remote work location model upon completing the necessary steps and receiving HR approval. The incumbent approved to telecommute may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs determined by IEHP leadership.

Work Model Location


Physical Requirements

Hearing: One-on-One - FREQUENTLY
Communicate: Information/ideas verbally - FREQUENTLY
Near Visual Acuity - FREQUENTLY
Regular contacts: co-workers, supervisor - FREQUENTLY
Understand and follow direction - FREQUENTLY
Regular and reliable attendance - CONSTANTLY
Keyboarding: 10-Key - FREQUENTLY
Keyboarding: Touch-Screen - FREQUENTLY
Keyboarding: Traditional - FREQUENTLY

A reasonable salary expectation is between $118,248.00 and $150,779.20, based upon experience and internal equity.

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region, designated as “Great Place to Work.” With a provider network of more than 5,000 and a team of more than 3,000 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award-winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.

Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles