Registered Nurse - HCC/RAF Coding Specialist
About The Position
Baystate Health is seeking a Registered Nurse - HCC/RAF Coding Specialist to join our Population Health team in Springfield, Massachusetts. This role supports Baystate Health's Value-Based Care and Population Health initiatives by conducting comprehensive medical record reviews, identifying risk-adjustment opportunities, and ensuring accurate and compliant clinical documentation for Medicare populations. The Registered Nurse - HCC/RAF Coding Specialist role offers the opportunity to combine clinical expertise with coding, quality, and population health initiatives while partnering closely with providers and practice staff across the Baystate Health system. This position plays a critical role in improving documentation quality, supporting Medicare Risk Adjustment (RAF) accuracy, enhancing patient outcomes, and advancing organizational quality and reimbursement goals.
Requirements
- Associate Degree in Nursing (ADN) required.
- Current Massachusetts Registered Nurse (RN) license required.
- Minimum of three (3) years of clinical RN experience required.
- Valid driver's license required.
- Experience with electronic medical record systems.
- Strong clinical knowledge of chronic disease management.
- Knowledge of ICD-10-CM coding, CMS HCC guidelines, Medicare Risk Adjustment methodologies, HEDIS, and Clinical Documentation Improvement (CDI) principles.
- Excellent communication, organizational, analytical, and problem-solving skills.
- Proficiency with Microsoft Office applications and electronic medical record systems.
- Ability to work independently while managing multiple priorities and maintaining high productivity, accuracy, and quality standards.
Nice To Haves
- Bachelor of Science in Nursing (BSN) preferred.
- Physician practice clinical experience.
- Experience with HCC/RAF coding, Medicare Risk Adjustment, Clinical Documentation Improvement (CDI), or Population Health initiatives.
- Cerner experience preferred.
- Strong presentation, facilitation, provider education, and relationship-building skills.
- Self-motivated with a commitment to continuous learning and maintaining current knowledge of CMS HCC, ICD-10-CM, Medicare Risk Adjustment, and related regulatory guidelines.
Responsibilities
- Review medical records and assign accurate ICD-10-CM diagnosis codes in accordance with CMS HCC guidelines.
- Identify documentation gaps and collaborate with providers to clarify incomplete, conflicting, or ambiguous documentation.
- Maintain accurate patient problem lists by adding, updating, and resolving diagnoses as appropriate.
- Identify and validate chronic conditions that impact Medicare Risk Adjustment (RAF) and quality reporting initiatives.
- Educate providers and clinical staff on HCC coding, documentation improvement strategies, and coding best practices.
- Utilize risk adjustment analytics and reports to prioritize chart reviews, provider education, and documentation improvement efforts.
- Support Medicare Annual Wellness Visits, Population Health initiatives, clinical outcome programs, and quality improvement activities.
- Serve as a clinical coding resource while promoting compliance with CMS regulations, ICD-10-CM coding standards, and organizational policies.
Benefits
- Competitive Pay & Benefits: Excellent compensation with high-quality, low-cost medical, dental, and vision coverage.
- Tuition & Training: Certification and continuing education reimbursement.
- Career Growth: Opportunities to expand expertise in Population Health, Clinical Documentation Improvement, Risk Adjustment, and Value-Based Care initiatives.
- Regional Opportunities: Career opportunities across Baystate Health hospitals, medical practices, and services throughout western Massachusetts.
- Retirement: 403(b) retirement plan with company match and annual company contribution increases based on years of service.
- Paid Time Off: Generous PTO for eligible employees.
- Additional Benefits: Life insurance, pet, home, auto, and personal insurance; free financial coaching; reimbursement for wellbeing activities including gym memberships, fitness equipment, personal training, massage therapy, and more; and comprehensive wellbeing programs supporting mental, physical, and financial health.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
