{"id":2600813,"url":"https://alion.io/job/elders-senior-encounter-data-coding-specialist","title":"Senior Encounter Data & Coding Specialist","company":{"id":4416177,"name":"Elders","domain":"elders.org","url":"https://alion.io/company/elders-2","size_band":null,"is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Jobvite","truth_index":null},"role":"Data Science","role_family":"Data Science","seniority":"senior","employment_type":null,"work_mode":"on_site","remote_scope":null,"remote_scope_basis":null,"remote_working_hours":null,"hiring_geo_confidence":"structured","locations":["Oakland, United States"],"countries":["US"],"hiring_countries":[],"hiring_countries_total":0,"salary":{"min":95721,"max":145496,"currency":"USD","period":"year","gross":null,"usd_annual":145496},"salary_estimate":null,"experience_years_min":5,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[{"name":"Microsoft Excel","optional":false},{"name":"Power BI","optional":false},{"name":"SQL","optional":false}],"status":"live","first_seen_at":"2026-10-15T08:00:37Z","employer_posted_date":"2026-10-15","last_verified_at":"2026-10-15T23:10:37Z","board_verified":true,"closed_at":null,"days_open":0,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":0},"description":"Description\nSenior Encounter Data & Coding Specialist\nThe Center for Elders’ Independenceis a PACE (Program of All-Inclusive Care for the elderly) organization that uses an interdisciplinary team approach to care planning and care implementation for the purpose of providing high quality, affordable, integrated health care services to the elderly, including an Adult Day Health Center, and promoting autonomy, quality of life and the ability of individuals to live in their communities.\nThe Position: The Senior Encounter Data & Coding Specialist ensures completeness, accuracy, and regulatory compliance of encounter data, diagnosis coding, and support clinical documentation for CMS, Medicare, Medicaid, and PACE reporting. This senior individual-contributor role combines encounter oversight, coding validation, error resolution, reconciliation, concurrent and retrospective coding review, and clinical documentation improvement.\nThe Specialist collaborates closely with clinical staff, providers, Health Information Management (HIM), and Information Technology teams to identify and resolve encounter and coding discrepancies while supporting revenue integrity, risk adjustment, and regulatory compliance.\nThe annualpay range for the Senior Encounter Data & Coding Specialistposition at Center for Elders’ Independence is $95,721 to $145,496. Placement within the range is determined based on job-related factors such as relevant experience, skills, abilities, internal equity, and market data, consistent with CEI’s annual compensation review and established compensation practices\nDUTIES AND RESPONSIBLITIES:\nReview, validate, monitor, and reconcile encounter data submissions.\nInvestigate encounter rejections, edits, denials, and discrepancies.\nCorrect and resubmit encounter records, as necessary.\nPerform encounter reconciliation between electronic health records, billing systems, claims systems, and CMS submission reports.\nMonitor encounter acceptance, rejection, and resubmission rates; identify trends affecting submission timeliness and accuracy; and escalate material issues with recommended corrective actions.\nDevelop and maintain encounter data quality controls.\nConduct concurrent and retrospective coding reviews of participant records.\nAssign and validate ICD-10-CM diagnosis codes based on clinical documentation.\nVerify appropriate capture of chronic conditions and risk-adjusting diagnoses.\nReview documentation to ensure coding compliance and accuracy.\nIdentify documentation deficiencies and initiate provider queries as appropriate.\nCollaborate with providers and clinical staff to improve documentation quality.\nServe as the primary resource for encounter error investigation and resolution.\nAnalyze CMS submission reports and identify root causes of recurring errors.\nCreate corrective action plans for encounter and coding issues.\nMaintain dashboards and reports related to encounter performance metrics.\nPrepare reports for Revenue Cycle, Finance, Compliance, and Executive Leadership.\nSupport accurate capture of Medicare risk adjustment diagnoses.\nValidate documentation supporting HCC conditions.\nPartner with clinical teams to ensure complete annual diagnosis capture.\nParticipate in chart reviews and coding audits related to risk adjustment activities.\nEnsure compliance with CMS, Medicare, Medicaid, and PACE regulations.\nSupport internal and external audits.\nAssist in the development of policies and procedures related to encounter data and coding.\nMaintain documentation supporting audit readiness.\nWork closely with: Physicians, Nurse Practitioners, IT.\nProvide education and feedback regarding coding, documentation, and encounter requirements.\nQUALIFICATIONS:\nBachelor's degree in Health Information Management, Healthcare Administration, Nursing, Business Administration, or related field preferred.\nMinimum five years of healthcare experience spanning encounter data, medical coding, revenue cycle, risk adjustment, or Health Information Management, including progressively responsible work in data validation, coding review, reconciliation, or regulatory reporting.\nMinimum three years of experience with PACE, Medicare Advantage, managed care, risk adjustment, or encounter data; direct PACE experience preferred.\nExperience investigating encounter submission errors and performing reconciliation activities.\nCertified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA) preferred; CPC or CRC strongly preferred. Equivalent proven ability in ICD-10-CM coding, risk adjustment, and encounter-data validation may be considered.\nDemonstrated knowledge of ICD-10-CM coding guidelines.\nMust demonstrate knowledge of Medicare risk-adjustment methodologies, CMS Encounter Data System requirements and reports, Electronic Health Records, revenue-cycle workflows, claims and encounter processing, and applicable CMS regulatory requirements, including diagnosis submission through EDS.\nTechnical skills preferred Microsoft Excel (advanced level), SQL, Power BI, Healthcare analytics tools.\nMust have excellent analytical, organizational, and problem-solving skills.\nAnalytical problem-solving, Attention to detail, Data reconciliation, Coding accuracy, Regulatory compliance, Relationship building, \nStrong written and verbal communication skills.\nThe above job description is intended to communicate the general function of the mentioned position and by no means shall be considered an exhaustive or complete outline of the specific tasks and functions that will be required.CEI reserves the right to change job descriptions, site assignments, and or work hours as required by the needs of the program.All employees are expected to perform their duties within their ability as required by the job and/or as requested by management.\n\nCenter for Elders’ Independence is a PACE (Program of All- Inclusive Care for the Elderly) organization that uses an interdisciplinary team approach to care planning and care implementation for the purpose of providing high quality, affordable, integrated health care services to the elderly, including an Adult Day Health Center, and promoting autonomy, quality of life and the ability of individuals to live in their communities. Unlike other healthcare plans, CEI is not a \"fee-for-service\" plan. It is a “capitation” healthcare plan. CEI is paid a set amount for each person enrolled in our program, whether or not that individual seeks care. We are a growing company that offers stability and continues to thrive.","description_format":"text","description_chars":6644,"description_truncated":false,"requirements":{"experience_years_min":5,"management_years_min":null,"team_size_min":null,"manages_managers":false,"education":{"level":"bachelor","optional":false},"security_clearance":false,"languages":[]},"benefits":["Equity"],"hiring_locations":[],"hiring_excludes":[],"relocation_offered":false,"industries":["Care Coordination & Population Health"],"lifecycle":[{"event":"open","at":"2026-10-15T08:00:37Z"}],"visa":[],"liveness":{"score":86,"band":"hot","label":"Hiring now","p_open":1,"p_active":0.86,"p_room":1,"age_days":0,"expected_fill_days":23,"reasons":["conf:2","win:early"],"computed_at":"2026-10-16T01:32:10Z"},"pay":{"stated_usd_annual":145496,"is_top_pay":false},"html_url":"https://alion.io/job/elders-senior-encounter-data-coding-specialist","json_url":"https://alion.io/job/elders-senior-encounter-data-coding-specialist.json","meta":{"generated_at":"2026-10-16T01:32:10Z","cache_seconds":300,"methodology":"https://alion.io/methodology","terms":"https://alion.io/terms","contact":"https://alion.io/contact","api":"https://alion.io/developers","about":"Alion is a live layer of people, companies and AI agents: who they are, whether they are real and active right now, what they do and how to work with them, readable by people and by agents and paid per call.","catalog":"https://alion.io/catalog.json","usage":{"tier":"crawler_verified","counted_by":"address","units_charged":1,"used_today":2383,"day_limit":null,"remaining_today":null,"minute_limit":300,"resets_at":"2026-10-17T00:00:00Z"}},"offers":[{"id":"company.slices","title":"One company in depth, by slice","status":"live","price":{"credits":0.02,"usd":0.002,"plus_per_slice":{"credits":0.05,"usd":0.005}},"unit":"per company, plus each slice with data","note":"the employer in depth","call":{"mcp_tool":"get_company","arguments":{"id":4416177},"rest":"https://alion.io/mcp/rest/get_company?id=4416177"},"human":"https://alion.io/catalog?offer=company.slices&for=job%2Felders-senior-encounter-data-coding-specialist"},{"id":"market.stats","title":"A market slice: pay, demand and time to fill","status":"live","price":{"credits":1,"usd":0.1},"unit":"per slice","note":"pay, demand and time to fill for this role and place","call":{"mcp_tool":"market_stats"},"human":"https://alion.io/catalog?offer=market.stats&for=job%2Felders-senior-encounter-data-coding-specialist"},{"id":"job.search","title":"Open jobs by role, technology, place, pay and visa","status":"live","price":{"credits":0.02,"usd":0.002},"unit":"per posting in a list","note":"similar open postings","call":{"mcp_tool":"search_jobs"},"human":"https://alion.io/catalog?offer=job.search&for=job%2Felders-senior-encounter-data-coding-specialist"},{"id":"company.verify","title":"Is this company real and active right now","status":"pilot","price":null,"unit":"per company","request":{"url":"https://alion.io/catalog/request","method":"POST","body":"{\"offer\": \"company.verify\", \"for\": \"job/elders-senior-encounter-data-coding-specialist\", \"note\": \"what you need it for\"}"},"human":"https://alion.io/catalog?offer=company.verify&for=job%2Felders-senior-encounter-data-coding-specialist"}]}