Risk Adjustment Coding Specialist

Gather Health•Boston, MA

1d•Remote

About The Position

Gather Health is seeking a Risk Adjustment Coding Specialist to join our growing team. This role is critical to ensuring the accuracy and completeness of diagnosis documentation and coding to support value-based care under Medicare Advantage and ACO REACH contracts. The ideal candidate has a deep understanding of HCC and CPT coding, is detail-oriented, and has strong interpersonal skills to provide feedback and education to PCPs. This role is primarily remote but may require periodic onsite meetings for one-on-one or group provider educational sessions, and team meetings as needed. Gather Health delivers Social Primary Care to older adults. Through our unique and differentiated care model and proprietary technology, Gather Health’s solution drives substantial care outcomes by addressing the whole person needs of our target demographic: older, dual eligible adults, the fastest growing government segment. To address the needs of these clinically and socially complex patients, Gather Health’s Social Primary Care solution is comprehensive and wholistic in nature, encompassing care and community within the four walls of Gather Health Centers and in the homes of its patients. Gather’s model achieves superior care by individualizing care and is reinforced by a three-prong approach: a unique care model quarterbacked by PCPs and supported by multi-disciplinary care teams, tailored Social Care Plans that are led by Gather Guides and facilitated by deeply rooted community partners, and a proprietary “Tech Enabled Home Model.” Founded in 2022 and born out of the Healthcare Foundry Portfolio, Gather Health is addressing a $1 trillion market in primary care for older adults. Today, Gather Health operates in Massachusetts and is working with a multitude of payer partners on aligning value-based care economics to deliver integrated care. Gather’s leadership team has a track record of building and scaling innovative primary care platforms focused on vulnerable populations, including VillageMD and Commonwealth Care Alliance. Gather has raised $30M backed by Maverick Ventures, Khosla, and HC9 Ventures. We are committed to supporting every aspect of your life by offering a total rewards package designed to support your health, financial security, and work-life balance:

Requirements

Two (2)+ years previous experience as a certified professional coder
Certified Professional Coder through the American Academy of Professional Coders (AAPC) or Certified Coding Specialist through the American Health Information Management Academy (AHIMA)
High school diploma or equivalent
Able to multitask, prioritize, and manage time efficiently
Self-motivated and self-directed; able to work without supervision
Excellent verbal, written, and interpersonal communication skills
Proficient computer skills, Microsoft Office Suite (Word, PowerPoint, Outlook, and Excel).

Nice To Haves

AS degree in accounting, health care administration, finance, business, or related field preferred

Responsibilities

Making sure that codes are assigned correctly and sequenced appropriately as per government and insurance regulations
Complying with medical coding guidelines and policies
Reviewing patients’ charts and documents for verification and accuracy (retrospective, prospective and Concurrent Chart Review)
Maintaining productivity and quality standards as set by the company
Communicating professionally with co-workers regarding clinical and reimbursement issues
Reporting missing or incomplete documentation while working with the providers to fix documentation errors.
Following up and clarifying any information that is not clear to PCPs.