Clinical Risk Adjustment Coder

Alpine Physicians•Denver, CO

About The Position

The Clinical Risk Adjustment Coder reviews medical records and provider documentation to identify, validate, and accurately code chronic conditions and diagnoses in accordance with Hierarchical Condition Category (HCC) risk adjustment models. The role supports accurate risk score capture, provider education, and compliance with CMS and payer coding guidelines. The position combines remote or hybrid chart review work with patient assessments conducted in person in patients’ homes throughout the Denver and Colorado Springs, Colorado areas or virtually. Reliable transportation is required for in-home visits. Reliable internet access and a secure home workspace are required for remote and virtual work to maintain HIPAA and data security compliance.

Requirements

MD, DO, NP, PA, or equivalent medical degree or licensure.
Active coding certification such as CRC (Certified Risk Adjustment Coder), CPC, CCS, or equivalent through AAPC or AHIMA.
At least 2 years of experience in medical coding; direct HCC or risk adjustment coding experience is strongly preferred.
Working knowledge of ICD-10-CM coding guidelines and CMS HCC risk adjustment models.
Strong understanding of medical terminology, anatomy, physiology, and disease processes.
Proficiency with electronic health record (EHR) systems and coding software.
Excellent attention to detail and analytical skills, with the ability to work independently in a remote or hybrid environment.
Strong written and verbal communication skills, including the ability to communicate coding findings to clinical staff.
Reliable transportation for in-home visits.
Reliable internet access and a secure home workspace for remote and virtual work.

Nice To Haves

Experience in a value-based care, ACO, or managed care environment.
Prior experience conducting provider education or documentation improvement training.
Prior experience performing in-home health assessments or annual wellness visits.

Responsibilities

Review medical records, encounter notes, and provider documentation to identify and validate diagnosis codes relevant to HCC and other risk adjustment models.
Conduct in-home or virtual health assessments with patients, evaluating and documenting chronic conditions to support accurate risk adjustment coding.
Assign and verify ICD-10-CM codes in accordance with official coding guidelines, CMS risk adjustment requirements, and payer-specific policies.
Conduct retrospective and prospective chart reviews to identify gaps in documentation and coding accuracy.
Collaborate with providers and clinical staff to clarify documentation and support accurate capture of chronic conditions.
Provide feedback and education to providers on documentation improvement opportunities related to risk adjustment coding.
Monitor coding accuracy through internal audits and quality assurance reviews, identify trends, and recommend corrective action.
Stay current on CMS and payer-specific risk adjustment methodology updates, including changes to HCC models and ICD-10-CM guidelines.
Maintain compliance with HIPAA and applicable privacy and security regulations when handling protected health information.
Partner with quality, analytics, and compliance teams to support risk adjustment initiatives and reporting.
Maintain and update patient data for long-term tracking and reporting.