• Provide support to assigned Segment Specialists by maintaining current audit concepts • Responsible for the review and update of existing concepts based upon required periodic review cycle • Collaborates with and leverages Segment Specialist expertise to ensure on-point results • Ensure training material updates as necessary for changes to existing concepts • Conduct research, identify impact on existing concepts, and document accordingly • Support activities required to "package" concepts, including, but not limited to, pulling together necessary documents • Ensure audit concepts are well formulated for Offerings • Manage, progress, and track multiple tasks within multiple workflows for audit concept maintenance • May contribute to responses to provider/client representative from written inquiries as it pertains to audited Medicare claims

• The Coding Inpatient, Outpatient, and Pro Fee Team Supervisor must be proficient in medical coding and have experience overseeing coding teams. • The Supervisor will conduct training and initial QA reviews for their direct reports. • Supervisors must be able to review clinical documentation and diagnostic results as needed to extract data and apply the appropriate ICD-10 diagnosis codes, CPT/PCS codes, and other relevant coding standards. • Under the direction of the Coding Manager, Supervisors should be proficient in communicating with coding teams, client contacts, and providers regarding the coding of conditions and procedures. • Responsibilities may include overseeing teams that work on coding-related denials from payers and recommending appropriate actions to resolve claims based on payer guidelines. • Additionally, Supervisors should be proficient in Excel to create reports as requested and must maintain professional communication with all levels of personnel, both internally and externally. • Travel to client sites may be required at times.

• Evaluates medical records and assigns appropriate clinical diagnosis and procedure codes • Analyzes medical information from medical records • Accurately codes diagnostic and procedural information • Consults with medical providers for accurate coding • Provides timely and accurate coding according to department standards • Abstract clinical diagnoses and procedures into electronic medical records • Ensures compliance with coding rules and regulations • Works independently under regular supervision

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description We are looking for a Certified Risk Adjustment Coder who is passionate about supporting accurate and compliant documentation for our PACE participants. This role requires a self-starter who thrives in an independent, remote environment, with strong critical thinking skills and a drive to deliver the highest quality outcomes. The ideal candidate will have hands-on expertise in both CMS-HCC v24 and v28 models and the ability to apply coding standards across multiple workflows. - Review participant medical records and provider documentation to identify, validate, and code risk-adjustable diagnoses in accordance with CMS-HCC v24 and v28 guidelines. - Ensure complete, accurate, and compliant ICD-10-CM coding with a primary focus on concurrent and retrospective reviews (with flexibility for pre-visit planning as needed). - Draft and submit compliant provider queries to clarify documentation and support accurate coding. - Track and follow through on open queries—engaging with providers, monitoring responses, and closing them out appropriately. - Apply strong critical thinking skills to resolve complex documentation and coding scenarios. - Maintain clear, professional communication with providers and internal teams to support documentation completeness. - Stay current with CMS, OIG, and industry regulations related to risk adjustment and coding compliance. Qualifications - Active CRC (Certified Risk Adjustment Coder) required. - Minimum of 1 year of experience in risk adjustment coding. - In-depth knowledge of ICD-10-CM and CMS-HCC models v24 and v28. - Demonstrated ability to work independently, stay organized, and follow through on tasks with minimal oversight. - Strong written and verbal communication skills, with the ability to engage providers in a professional and solutions-oriented manner. - High attention to detail and ability to critically analyze clinical documentation. - Proficiency with electronic health records (EHR) and Microsoft Excel. - Aligns with our purpose and our values, and is excited about living those out in daily practice. Requirements - Experience as a risk adjustment coder in PACE, long-term care, or complex care populations (nice to have). - Background in clinical documentation improvement (CDI) or coding quality assurance (nice to have). - Experience with Epic/OCHIN systems (nice to have). Benefits - Medical/dental/vision insurance. - Short and long-term disability. - Life insurance. - Flexible spending accounts. - 401(k) savings. - Paid time off. - Company-paid holidays. - Expected salary range: $24-$27 hourly and is bonus eligible.