Risk Adjustment Coder I - Sacramento (Central/South) Hybrid 25-234
About The Position
The Risk Adjustment Coder I provides support and coding expertise to all programs supporting risk adjustment and data validation efforts for Medicare and Commercial lines of business, as well as other ad hoc and long-term projects assigned by the Manager, Government Programs. These projects directly impact revenue and prepare the organization for health plan, CMS, and HHS audits. The Risk Adjustment Coder I will develop analytics, create education materials, conduct in-person and virtual provider trainings, and serve as the subject matter expert (SME) for all HCC coding initiatives. This position requires significant interaction with physician leadership, the provider network, and various internal departments (e.g., Regional Services, Clinical Services, and Case Management). Building and maintaining strong relationships across the organization is critical to success.
Requirements
- Proficient in Microsoft Excel, Word, and PowerPoint.
- Strong written and verbal communication skills.
- Ability to effectively operate in hybrid (in-person and virtual) work environments.
- Familiarity with EMR systems (Epic experienced preferred).
- Strong organizational skills and attention to detail.
- Ability to work independently and effectively problem-solve.
- Proven ability to clearly communicate verbally and in writing.
- Certified professional medical coding credentials
- 1+ year of experience in HCC coding and auditing (medical chart review).
- Valid driver’s license and proof of auto insurance.
- AAPC/AHIMA Certification.
Nice To Haves
- Experience working in a healthcare or physician office setting preferred.
- Bachelor’s degree preferred plus experience in a healthcare setting.
Responsibilities
- Perform risk adjustment data validation to ensure accurate and compliant code submission.
- Develop and present HCC education materials for practices, panel meetings, new physician orientation, provider specialty management teams (SMT), and internal departments.
- Facilitate “Train the Trainer” sessions on risk adjustment and coding interventions for internal teams to educate the provider network.
- Conduct in-person and virtual trainings for providers and staff, adapting content to meet the needs of hybrid work environments.
- Coordinate Annual Wellness Visit (AWV) and quality resources; monitor and evaluate performance of related interventions.
- Responsible for presenting Government Programs updates at various forums (e.g., Practice Manager Meetings, SMT, HillMetrics Support Forums).
- Assists management with onboarding and training of new hires and represent the team at health plan partner meetings.
- Identify opportunities to improve documentation and coding accuracy; provide analysis and initiate HCC coding interventions with practices to enhance performance.
- Analyze internal systems and processes to identify and resolve issues that hinder accurate encounter data capture.
- Conduct prospective reviews of current and suspect conditions to optimize documentation and coding.
- Provide real-time education and feedback during patient visits to ensure accurate health status capture.
- Conduct billing education/review to ensure all codes are captured on claim.
- Monitor and track practice performance in the areas of HCC recapture, suspect recapture, and RAF score improvements.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Number of Employees
501-1,000 employees
