We are seeking a highly experienced Senior Risk Adjustment Coder to play a critical role in risk adjustment accuracy, audit readiness, provider education, and clinical documentation excellence.
This role supports a leading healthcare organization focused on accurate HCC capture, audit readiness, documentation integrity, and provider engagement. The position involves pre-visit reviews, concurrent reviews, retrospective audits, documentation validation, provider-facing education, and CMS-compliant HCC coding practices.
The Senior Risk Adjustment Coder works closely with clinicians, coding leadership, compliance teams, and operational stakeholders to improve documentation quality, RAF accuracy, and overall coding integrity.
Responsibilities include performing risk adjustment coding and chart abstraction aligned with CMS guidelines and Medicare Advantage Risk Adjustment models, conducting coding audits and validation reviews, ensuring documentation supports CMS-compliant coding standards and M.E.A.T. criteria, communicating coding recommendations with providers, supporting clinical documentation improvement initiatives, and staying current with CMS regulations and best practices.
Work model is primarily remote with hybrid operational expectations, including quarterly in-person meetings and ad hoc onsite visits. Flexible schedule Monday–Friday with start times between 6:30 AM – 8:00 AM PST.
Certified Professional Coder (CPC) and Certified Risk Adjustment Coder (CRC) required. 5+ years of dedicated Risk Adjustment / HCC coding experience. Strong knowledge of Medicare Advantage and CMS Risk Adjustment models. Experience with pre-visit reviews, concurrent reviews, retrospective audits, documentation validation, and suspecting workflows. Strong understanding of HCC capture, recapture, RAF impact, and coding compliance principles. Experience working directly with providers on documentation clarification and coding education. Familiarity with EHR systems (Epic preferred) and coding/audit tools. Excellent analytical, communication, and collaboration skills. Ability to navigate provider conversations professionally.
Referral bonus: $500 for referring a friend who completes 20 shifts. Flexible start times and hybrid remote work with operational collaboration. Opportunity to work with a leading healthcare organization focused on quality care and coding excellence.
Location
Newark, California, US
Employment Type
Full-time
Experience Level
Senior
Salary Range
$91,000 - $119,000
Remote work allowed
Yes
Posted
1 month ago