Manager, Risk Coding

Community Care Cooperative•Boston, MA

3d•$91,042 - $109,250•Hybrid

About The Position

Community Care Cooperative (C3) is a 501(c)(3) nonprofit multi-service organization governed by Federally Qualified Health Centers (FQHCs). It operates as an FQHC-led accountable care organization (ACO) and as a management services organization for FQHCs, providing services that include value-based contract management, population health, Epic EHR licensing and implementation, pharmacy operations, billing, and credentialing. The Manager, Risk Coding leads a team delivering retrospective and prospective risk coding for FQHCs and partner networks participating in C3’s MassHealth ACO and Medicare ACO (Medicare Shared Savings Program) contracts. The role applies coding expertise and claims-submission knowledge to improve documentation accuracy and support appropriate risk adjustment. The manager oversees coding quality assurance, team hiring and onboarding, training, productivity and quality management, and monthly performance reporting to participating health centers. The position reports to the Senior Director, Risk Adjustment and collaborates with internal teams and FQHC billing, population health, and provider staff. The role supports Medicare risk adjustment under the CMS-HCC model, including Version 28, and Medicaid risk adjustment under the MassHealth DxCG model.

Requirements

At least 5 years of risk coding experience.
At least 3 years of experience supporting Medicare ACO (MSSP or ACO REACH) or Medicare Advantage risk adjustment programs, with working knowledge of the CMS-HCC model, including Version 28.
Working knowledge of Medicaid risk adjustment models, including the MassHealth DxCG model.
At least 5 years of outpatient medical billing experience, preferably in primary care, pediatrics, or behavioral health.
2–4 years of leadership experience managing medical coding or risk adjustment coding teams, including productivity and quality management.
Billing compliance expertise.
Experience using data analysis and performance reports on metrics such as risk scores, condition recapture rates, coder productivity, and coding accuracy.
Familiarity with population health management tools such as Arcadia.
In-depth knowledge of medical terminology, anatomy, physiology, and disease processes.
Knowledge of electronic health record systems such as Epic, NextGen, Centricity, and eCW.
Self-starter who exercises initiative, judgment, discretion, and decision-making to achieve objectives.
Proficiency with MS Office.
Integrity, accuracy, and close attention to detail, especially when completing final deliverables for internal and external stakeholders.
Bachelor’s degree in business administration, healthcare administration, public health, or a healthcare-related field.
Current AAPC Certified Professional Coder (CPC) or AHIMA Certified Coding Specialist (CCS) certification required.
Employees must be vaccinated consistent with applicable law and Mass.gov-recommended infection-control practices.

Nice To Haves

Expertise in both Medicaid (DxCG) and Medicare (CMS-HCC) risk adjustment models.
Experience within MassHealth ACO and Medicare ACO (MSSP) programs, including value-based care and shared savings performance.
Familiarity with Federally Qualified Health Centers.
Experience leading remote or hybrid teams supporting multiple health centers and EHR environments.
Familiarity with risk adjustment analytics vendors and reporting tools such as Milliman.
Experience with anti-racism activities and/or lived experience with racism is highly preferred.
AAPC Certified Risk Adjustment Coder (CRC) certification preferred.

Responsibilities

Serve as an expert on ICD-10-CM coding guidelines, AHA Coding Clinic Guidance, and risk adjustment methodologies.
Maintain quality assurance for coding projects by conducting internal audits of charts reviewed by the coding team.
Review records using common EHRs, especially Epic, NextGen, Centricity, and eCW.
Develop and deliver provider reports on findings and facilitate feedback loops for allowable bill modifications.
Use population health reporting tools to help create pre-visit coding workflows.
Develop and maintain coding educational tools.
Assess team performance and provide employee feedback.
Hire and train employees and develop standard operating procedures for the coding team.
Oversee the coding team’s day-to-day operations and performance.
Manage day-to-day delivery of risk adjustment coding shared services, including monthly production targets, turnaround standards, and health center reporting commitments.
Support C3’s Medicare ACO (MSSP) risk adjustment strategy, including CMS-HCC Version 28 condition recapture, documentation integrity, and coding accuracy, alongside MassHealth ACO (DxCG) coding operations.
Establish, monitor, and report coder productivity and quality metrics, including charts reviewed per day, coding accuracy, and turnaround time; coach team members toward performance targets.
Partner with Provider Educators and coding quality staff to use audit findings for provider education and workflow improvements, framed as educational clinical documentation improvement rather than coding directives.
Ensure coding practices align with CMS, OIG, MassHealth, and C3 compliance expectations, and escalate compliance concerns to the Senior Director, Risk Adjustment and Compliance as appropriate.
Prepare and present monthly coding performance updates to health center leadership and internal stakeholders.
Perform other duties as assigned.