Drive accuracy, influence outcomes, and protect revenue.
This senior-level Risk Adjustment Coder role supports a healthcare organization focused on accurate HCC capture, audit readiness, documentation integrity, and provider engagement. The position is highly operational and collaborative rather than a traditional production-only coding role.
You will work across pre-visit reviews, concurrent reviews, retrospective audits, documentation validation, and provider-facing education to improve documentation quality, RAF accuracy, and overall coding integrity. The role partners closely with clinicians, coding leadership, compliance teams, and operational stakeholders.
Key Responsibilities
- Perform risk adjustment coding and chart abstraction in alignment with CMS guidelines and Medicare Advantage risk adjustment models
- Conduct pre-visit chart reviews to identify suspect conditions, coding gaps, and documentation opportunities
- Perform concurrent and retrospective coding audits and validation reviews to ensure accuracy and compliance
- Identify opportunities for HCC capture, recapture, and suspecting workflows
- Review historical encounters, labs, and supporting clinical documentation to validate chronic condition capture
- Ensure documentation supports CMS-compliant coding standards and M.E.A.T. criteria
- Communicate documentation clarification opportunities and coding recommendations directly with providers and clinical teams
- Support provider-facing clinical documentation improvement initiatives and coding education efforts
- Participate in provider onboarding, documentation education, and coding clarification discussions
- Collaborate with coding, compliance, operational, and revenue cycle teams to improve coding accuracy and audit readiness
- Support documentation defensibility and compliance initiatives related to risk adjustment coding
- Stay current with CMS regulations, ICD-10 guidelines, HCC model changes, and risk adjustment best practices
Work Model & Schedule
- Primarily remote role with hybrid operational expectations
- Quarterly in-person team meetings required
- Ad hoc onsite clinic visits and operational meetings as needed
- Potential next-day onsite requests based on business or provider support needs
- Monday through Friday schedule
- Flexible start times between approximately 6:30 AM and 8:00 AM PST
- Typical workday ends around 4:00 PM PST
Required Qualifications
- 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
- Strong audit and documentation review skills
- Familiarity with EHR systems, with Epic preferred, and coding/audit tools
- Excellent analytical, communication, and collaboration skills
- Ability to navigate provider conversations and documentation clarification discussions professionally
Preferred Attributes
- Detail-oriented and operationally mature
- Strong provider-facing communication skills
- Independent workflow ownership and problem-solving ability
- Ability to identify documentation gaps and coding opportunities effectively
- Compliance-focused coding judgment
- Comfort working cross-functionally with clinicians and operational teams
Perks
- Direct hire opportunity
- Primarily remote work arrangement with hybrid onsite collaboration
- Referral bonus available: $500 for qualifying referrals
Location
Sacramento, California, US
Employment Type
Full-time
Experience Level
Senior
Salary Range
$91,000 - $119,000
Remote work allowed
Yes
Posted
1 month ago