Risk Adjustment Coding Specialist
About The Position
Greater Good Health is seeking a Risk Adjustment Coding Specialist to manage retrospective CDI chart review, enhance coding compliance, ensure documentation accuracy, and optimize risk adjustment within their Medicare-focused primary care model. This role requires deep expertise in Medicare risk adjustment, a solid understanding of outpatient clinical documentation, and the ability to translate complex coding rules into actionable guidance for clinical and revenue teams. The specialist will collaborate with leaders in Revenue Cycle, Clinical Operations, and Clinical Performance to drive compliant, accurate, and optimized coding. Key responsibilities include resolving documentation and coding queries, clearing retrospective review backlogs before CMS filing deadlines, and identifying opportunities for improved risk capture while minimizing audit risk. Effective communication with both clinical and non-clinical stakeholders is crucial. The role involves designing and formalizing coding audit processes, documentation standards, and educational materials to ensure coding accuracy and consistency. The specialist will review charts, assist with query resolution, and provide insights on coding trends and regulatory changes impacting operations. The ideal candidate will apply extensive knowledge of Medicare risk adjustment coding to real-world clinical workflows, balancing compliance, operational efficiency, and scalability. This position 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
- CDI credential preferred (CDIP, CCDS, or equivalent) in addition to CRC
- 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
- Experience supporting or participating in coding audits or compliance reviews preferred
- 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 holidays, vacation time, and paid parental leave
- 401K Program with Company Match
- Monthly Phone/Internet Reimbursement
- 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
- Voluntary short-term disability (STD) coverage
- Collaborative and supportive GGH Nurse Practitioner Community, with dedicated care coordinators and MD advisors
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
