Community Health Choice, Inc. is a non-profit managed care organization (MCO) licensed by the Texas Department of Insurance. The organization serves over 400,000 members across Medicaid, CHIP, Health Insurance Marketplace plans, and Medicare Advantage Dual Special Needs coverage.
The Risk Adjustment Coder II provides advanced support for complex medical record reviews to ensure accurate capture of chronic conditions and complexities for risk scoring. This role maps diagnoses to Hierarchical Condition Categories (HCCs) while adhering to CMS guidelines and internal coding policies for Commercial Risk Adjustment, Medicare Risk Adjustment, and HHS and Medicare RADV programs.
The role serves as a subject matter expert for risk adjustment and supports team training, quality assurance audits, and cross-functional collaboration. It also contributes to documentation and coding improvement efforts and departmental goals.
Minimum Qualifications
- Bachelor's degree preferred; 5 or more years of risk adjustment experience may be substituted for the degree in a managed care organization
- AHIMA/AAPC certified coder or medical billing and coding certification required, such as CPC, CRC, COC, CCS, or CCS-P
- 3-5 years of experience in Commercial or Medicare risk adjustment coding
- Clinical documentation improvement experience for inpatient and outpatient settings preferred
- Experience within a managed care organization
- Strong analytical, written, verbal, and interpersonal skills
- Solid knowledge of ACA, Medicaid, and Medicare risk adjustment
- Proficiency with Microsoft 365, including Word, Excel, Outlook, SharePoint, and Teams
- Medical insurance
- Vision insurance
- Dental insurance
- 401(k)
- Tuition assistance
- Disability insurance
- Paid paternity leave
- Paid maternity leave
Location
Houston, Texas, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
3 weeks ago