Risk Adjustment Coding Specialist
About The Position
Greater Good Health is seeking a Risk Adjustment Coding Specialist to oversee retrospective CDI chart review, aiming to enhance coding compliance, documentation accuracy, and risk adjustment optimization within their Medicare-focused primary care model. The ideal candidate will possess extensive knowledge of Medicare risk adjustment, a solid grasp of outpatient clinical documentation, and the ability to translate complex coding rules into actionable advice for clinical and revenue teams. This role involves close collaboration with leaders in Revenue Cycle, Clinical Operations, and Clinical Performance to ensure coding is compliant, accurate, and optimized. Key responsibilities include resolving documentation and coding queries, managing retrospective review backlogs to meet CMS filing deadlines, and identifying opportunities to improve risk capture while minimizing audit risk. Effective communication with both clinical and non-clinical stakeholders is crucial. The specialist will also contribute to coding accuracy and consistency by helping to design and formalize coding audit processes, documentation standards, and educational materials. This involves reviewing charts, assisting with query resolution, and providing insights into coding trends and regulatory changes impacting operations. The role requires applying in-depth knowledge of Medicare risk adjustment coding to real-world clinical workflows, balancing compliance, operational efficiency, and scalability. It offers significant autonomy, a focused yet impactful scope, and the chance to strengthen the company's coding and compliance foundation during its growth phase.
Requirements
- Certified Risk Adjustment Coder (CRC or equivalent) required
- Medicare risk adjustment experience required
- Demonstrated Clinical Documentation Improvement (CDI) experience, including query construction, provider education, and documentation gap remediation
- Strong knowledge of ICD-10-CM coding guidelines, HCC models, and Medicare documentation requirements
- Experience in outpatient clinic and/or primary care settings
- Value-Based Care (VBC) experience
- Proficiency in Excel, including pivot tables, VLOOKUP/XLOOKUP, conditional formatting, and data validation, for chart audit tracking and trend reporting
- Experience building or maintaining audit worklists/trackers in Excel
- Strong communication skills with the ability to translate coding guidance for clinical, operational, and finance stakeholders
- Comfortable training and coaching providers on documentation and coding best practices, including delivering feedback on individual query patterns
Nice To Haves
- CDI credential preferred (CDIP, CCDS, or equivalent) in addition to CRC
- Experience supporting or participating in coding audits or compliance reviews preferred
Responsibilities
- Own retrospective CDI chart review for compliant, accurate and optimized coding
- Design and execute formal coding audits to ensure CPT and diagnosis coding are compliant and fully supported by clinical documentation
- Identify documentation gaps, education opportunities, and compliance concerns; support escalation and remediation efforts as needed
- Partner with Revenue Cycle to support claim corrections, rebilling, and documentation follow-up
- Assist with coding research for new or evolving CPTs and services, including documentation and billing requirements and Medicare reimbursement considerations
- Support resolution of coding and documentation queries, collaborating with providers to amend documentation where appropriate
- Develop coding and documentation education content for Nurse Practitioners and clinical teams, informed by audit findings and recurring themes
- Build and maintain CDI worklists and audit trackers in Excel, including formula-driven flags for missed HCCs, recapture opportunities, and documentation gaps
- Translate chart audit findings into structured Excel-based reporting (trend summaries, provider-level scorecards) for Revenue Cycle and Clinical Operations leadership
- Support Care Services leadership with open condition management and risk adjustment workflows, including coaching and training as needed
- Monitor and report on changes in the coding and risk adjustment landscape, including new, revised, or retired codes and regulatory guidance
- Help formalize coding-related processes and documentation suitable for internal policies and compliance reference
Benefits
- Lunch and parking provided every day in office
- Competitive Compensation Package
- Comprehensive Medical, Dental, and Vision Benefits
- Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) available
- Paid Time Off: paid holidays, vacation time, and paid parental leave
- 401K Program with Company Match
- Monthly Phone/Internet Reimbursement
- Comprehensive Life and AD&D Coverage: 100% premiums covered by GGH for Basic Life and Accidental Death & Dismemberment (AD&D) insurance for full-time team members
- Voluntary supplemental life insurance offered at a discounted rate
- Short-Term Disability Coverage
- Collaborative and Supportive Community
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
