• 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.

• Assigns codes accurately to diagnoses and procedures within the medical record to comply with federal and state regulations • Sequences codes accurately for proper and optimal DRG assignment • Queries physicians or hospital staff as needed to ensure proper assignment of codes • Abstracts data from the medical records and assures that all required elements are appropriately entered into the hospital information system • Completes coding according to established time frame and ensures reduced DNFB accounts • Maintains excellent accuracy rate for proper sequencing of codes for proper DRG assignment per coding guidelines • Discusses medical record information with providers, quality, and CDI when necessary, in accordance with coding guidelines • Contacts providers or other staff to obtain missing documentation or signatures timely in an effort to reduce DNFB accounts • Abstracts data with a high accuracy rate in accordance with established policy • Adapts to changing department demands evidenced by higher department efficiency • Ensures compliance with medical coding policies and guidelines • Maintains productivity standards per established monthly goals • Performs other duties as assigned

• Abstracts/codes for assigned provider(s)/division(s) based on medical record documentation. • Adheres to all coding and compliance guidelines. • Utilizes appropriate coding software and coding resources in order to determine correct codes. • Communicates billing related issues to assigned supervisor/manager and participates in meetings in order to improve overall billing, when applicable. • Follows departmental policies for charge corrections. • Participates in coding educational opportunities (webinars, in house training, etc.). • Provides feedback to providers in order to clarify and resolve coding concerns. • Resolves assigned pre-billing edits. • Assists in identifying areas that require additional training. • Mentors and assists in training other coders and new team members • Performs other duties as assigned.