Medicare Risk Adjustment Specialist I
About The Position
We are seeking a detail-oriented Medicare Risk Adjustment Coding Specialist to support our innovative AI-driven chart review and risk adjustment programs. This role differs from a traditional retrospective chart review position. Rather than conducting full manual chart reviews, the specialist will work alongside advanced AI technology to validate, refine, and support coding opportunities identified through automated chart analysis. The ideal candidate will possess strong knowledge of Medicare Advantage risk adjustment methodologies, HCC coding, and clinical documentation requirements, while demonstrating the ability to evaluate AI-generated coding recommendations and ensure accuracy, compliance, and coding integrity. This is a Full-Time role with expectation for 40 hours per week. We look forward to meeting interested applicants and mutually assessing fit in joining On Belay on our important mission to transform healthcare!
Requirements
- High school diploma or GED required. Associates degree preferred.
- Active coding certificate required. AAPC or AHIMA coding certification preferred.
- Required: CCS-P (Certified Coding Specialist- Physicianbased) or CPC (Certified Professional Coder)
- Preferred: CRC (Certified Risk Adjustment Coder)
- Experience in a primary care setting highly preferred.
- Knowledge of medical terminology and medical chart review required.
- Two (2) or more years’ experience of hierarchical condition categories (HCC)
- Knowledge of ICD-10-CM Official Guidelines for Coding and Reporting
- Knowledge of AHA Coding Clinic and authoritative coding resources
- Knowledge of Microsoft Office suite, primarily Excel (specifically Pivot Tables, sort and filter functions)
- Strong time management skills required
- Ability to navigate within various EMRs (Electronic Medical Records), Cerner Preferred
- Strong interpersonal, communication (verbal, non-verbal and listening) skills
- Ability to remain productive under time constraints and meet deadlines critical to the business
Nice To Haves
- Associates degree preferred.
- AAPC or AHIMA coding certification preferred.
- CRC (Certified Risk Adjustment Coder)
- Experience in a primary care setting highly preferred.
- Cerner Preferred
Responsibilities
- Review and validate AI-identified risk adjustment coding opportunities within medical records.
- Assess clinical documentation to determine the appropriateness of proposed diagnoses and HCC submissions.
- Support the quality assurance process for AI-assisted chart reviews by identifying coding discrepancies, false positives, and missed opportunities.
- Develop feedback loop with On Belay’s Head of Risk Adjustment Coding and physician offices On Belay supports, including but not limited to: Identification of quality improvement opportunities in individual physician coding
- Any other related duties assigned at manager’s discretion
Benefits
- Innovative, revolutionary environment
- Great culture with a strong sense of mission and community
- Eleven (11) Paid Holidays
- Lavish PTO accrual
- Advancement opportunities & professional skills training
- Strong referral bonus program
- And more!
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
