• Accurately coding diagnoses, procedures and other services to ensure medical records and billing are accurate • Work with providers to ensure documentation is clear and complete and result in accurate coding • Review all claim edits and correct errors in a timely fashion • Code for practice and hospital charges for all departments supported by the Professional Billing Office

Role Description Avail Health is a rapidly growing value-based care company delivering comprehensive, technology-enabled care programs to Medicare patients with complex medical, behavioral health, and social needs. Our care model spans a range of clinical programs including Comprehensive Diagnostic Assessments (CDAs), Health Risk Assessments (HRAs), and Integrated Care Programs (ICPs), all designed to address the whole-person needs of high-risk Medicare beneficiaries. As Avail Health continues to scale its clinical programs, we are seeking an experienced Risk Adjustment & Coding Expert to serve as a trusted fractional advisor to our clinical and operational leadership team. This role sits at the intersection of clinical documentation, Medicare coding compliance, and program-level performance—supporting our mission to deliver high-quality, accurately documented care that reflects the true complexity of our patient population. The Risk Adjustment & Coding Expert will: - Advise clinical leaders on proper HCC (Hierarchical Condition Category) coding practices. - Ensure documentation integrity across Avail's care programs. - Drive ongoing workflow design, policy development, and process improvement to support accurate and compliant risk adjustment coding. - Function as a subject-matter expert embedded within Avail's interdisciplinary team structure. This is a startup-style healthcare environment where subject-matter experts are expected to be hands-on, pragmatic, and solutions-oriented. The ideal candidate brings deep Medicare Advantage risk adjustment expertise, strong knowledge of CMS coding guidelines, and a track record of building scalable coding education and quality programs within complex care or value-based care organizations. Qualifications - Must have Certified Risk Adjustment Coder (CRC); Certified Professional Coder (CPC) also highly desirable. - Minimum 5 years of experience in Medicare risk adjustment coding, HCC coding, or clinical documentation improvement (CDI) required. - Deep knowledge of ICD-10-CM coding guidelines, CMS HCC models (V24, V28), and Medicare Advantage risk adjustment methodology. - Experience working in value-based care, Medicare Advantage, population health, or complex care management environments strongly preferred. - Prior experience advising clinical providers (NPs, MDs, RN Care Managers) on coding and documentation practices. - Experience designing or delivering coding education and training programs for clinical teams. - Familiarity with CDAs, HRAs, Annual Wellness Visits (AWVs), and Transitional Care Management (TCM) coding preferred. - Experience with RADV audits, coding compliance programs, and risk adjustment quality initiatives preferred. - Proficiency with EMR platforms, coding tools, and documentation review workflows. - Ability to work independently in a fractional/part-time capacity with strong self-direction and accountability. Requirements - Perform audits on existing coding staff. - Serve as the primary coding and risk adjustment subject-matter expert for Avail Health clinical leaders and frontline clinicians across CDAs, HRAs, and ICPs. - Advise Nurse Practitioners, Physicians, and RN Care Managers on accurate ICD-10-CM coding, HCC capture, and documentation requirements to support proper Medicare risk adjustment. - Review clinical encounter documentation and provide real-time feedback on coding accuracy, specificity, and completeness. - Identify coding gaps, missed HCC capture opportunities, and documentation deficiencies across care programs and patient populations. - Provide guidance on condition-specific coding requirements for high-prevalence chronic conditions within Avail's patient population (e.g., diabetes, CHF, COPD, CKD, behavioral health diagnoses). - Partner with clinical and operational leadership to design and implement coding workflows integrated into Avail's care program delivery model. - Develop and maintain coding and documentation policies, guidelines, and standard operating procedures (SOPs) aligned with CMS requirements and Medicare Advantage risk adjustment best practices. - Support the development of documentation templates, encounter coding checklists, and structured data capture tools within the EMR and care coordination platforms. - Define escalation pathways and quality review workflows for coding discrepancies, queries, and corrections. - Design and deliver ongoing coding education and training programs for Avail's clinical team, including onboarding content for new clinicians and refresher training for existing staff. - Develop program-specific coding guides, quick-reference tools, and clinical documentation resources for CDAs, HRAs, and ICPs. - Partner with the VP of Care Delivery and Medical Director to integrate coding best practices into clinical workflows, quality reviews, and care team huddles. - Support providers in navigating complex coding scenarios including dual diagnoses, behavioral health coding, and social determinants of health (SDOH) documentation. - Conduct coding audits and documentation reviews across a sample of clinical encounters to assess coding accuracy, completeness, and compliance with CMS and Medicare Advantage plan requirements. - Track and report on coding quality metrics, HCC capture rates, and risk adjustment performance trends to clinical and operational leadership. - Identify opportunities for process improvement related to risk adjustment documentation and coding workflows, and lead structured improvement initiatives. - Stay current on CMS HCC model updates, Medicare Advantage coding guidelines, and regulatory changes affecting risk adjustment; proactively communicate relevant changes to the team. - Support preparation for coding audits, RADV (Risk Adjustment Data Validation) reviews, and compliance activities as needed. - Provide targeted coding and documentation guidance specific to the clinical workflows and patient populations within each of Avail's core care programs. - Support alignment between CDA, HRA, and ICP documentation requirements and risk adjustment coding capture to ensure program integrity and compliance. - Collaborate with care program managers and clinical leads to embed coding best practices into program design, clinician onboarding, and ongoing quality oversight. Benefits - Fully remote/work from home supporting a fully distributed team across the US. - This is a fractional / part-time independent contractor (1099) engagement. - Hours and scope are flexible and will be defined collaboratively based on Avail Health's program needs. - Anticipated commitment ranges from 5 to 20 hours per week depending on program maturity, project phases, and organizational priorities. - Compensation will be commensurate with experience and engagement scope.

• Maximize reimbursement and minimize denials by assuring that proper coding guidelines have been met. • Work within the Providence footprint states: AK, MT, CA, OR, TX, NM, and WA.

Role Description Under limited supervision the Coder Inpatient reviews medical records and performs coding on all diagnoses, procedures, and DRG. The Coder Inpatient uses the most accurate codes for reimbursement purposes, research, epidemiology, statistical analysis outcomes, financial and strategic planning, evaluation of quality of care, and communication to support the patient’s treatment. The Coder Inpatient will be charged with maintaining the confidentiality of patient records and procedures. - Responsible for abstracting, coding, sequencing and interpreting the clinical information from inpatient, outpatient, emergency department, pro fee and clinical medical records. - Responsible for the assignment of correct principal diagnoses, secondary diagnoses and principal procedure and secondary procedure codes with attention to accurate sequencing. - Utilizes technical coding principals and DRG/APC reimbursement expertise to assign appropriate codes. - Abstracts and codes pertinent medical data into multiple software programs and/or encoders. - Follows official coding guidelines to review and analyze health records. - Maintains compliance with both external regulatory and accreditation requirements, and with State and Federal regulations. - Extracts pertinent data from the patient’s health record, and determines appropriate coding for reports and billing documents. - Identifies codes for reporting medical services, procedures performed by physicians. Enters codes into various computer systems dependent upon the various clients. - Track and document productivity in specified systems, maintain productivity levels as defined by the client. - Maintain 95% quality rating. - Perform duties in compliance with Company’s policies and procedures, including but not limited to those related to HIPAA and compliance. Qualifications - Ability to prioritize and multi-task in a fast-paced, changing environment. - Demonstrate ability to work in all work types and specialties. - Demonstrate ability to self-motivate, set goals, and meet deadlines. - Demonstrate leadership, mentoring, and interpersonal skills. - Demonstrate excellent presentation, verbal and written communication skills. - Ability to develop and maintain relationships with key business partners by building personal credibility and trust. - Maintain courteous and professional working relationships with employees at all levels of the organization. - Demonstrate excellent analytical, critical thinking and problem solving skills. - Skill in operating a personal computer and utilizing a variety of software applications. - Knowledge of coding convention and rules established by the AHIMA, American Medical Association (AMA), the American Hospital Association (AHA) and the Center for Medicare and Medicaid (CMS), for assignment of diagnostic and surgical procedural codes. - Knowledge of JCAHO, coding compliance and HIPAA HITECH standards affecting medical records and the impact on reimbursement and accreditation. Requirements - Successful completion of an AAPC or AHIMA-approved Coding Certificate Program. - A minimum of two to four years of current production coding experience in both acute care and profee. - Must have the following certificates and/or licenses: CPC, COC, CIC, RHIA, RHIT, CCS, and/or CCS-P. Benefits - Health, dental, and vision coverage. - Voluntary insurance options. - 401(k) plan with employer match. - Professional development opportunities. - Paid time off and holiday pay. - Opportunity to participate in bonus programs, commissions, or other variable incentive plans. Company Description Founded in 2003, Omega Healthcare Management Services® (Omega Healthcare) empowers healthcare to thrive via intelligent solutions that optimize revenue cycle operations, administrative workflows, care coordination, and clinical research on a global scale. The company works with providers, payers, life science companies, medical device manufacturers, health technology firms, researchers, and industry partners to amplify teams with robust technology, specialty expertise, and operational support. Omega Healthcare serves more than 350 healthcare organizations with 35,000 skilled workers in the United States, India, Colombia, and the Philippines.