Risk Adjustment Coding Specialist II (CST/EST)

About the role

We are currently seeking a highly motivated Risk Adjustment Coding Specialist to support our Houston market. This position requires travel to provider offices twice a week in the Houston area.

Responsibilities

• Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company
• Review medical record information on both a retroactive and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC)
• Translate findings into actionable insights, creating and delivering education to providers and practice leaders while navigating complex conversations
• Track and report on key performance metrics—such as HCC recapture rates, AWVs, and other KPIs, helping drive provider performance and overall program success

Qualifications

• Certification/Licensure: Must possess and maintain AAPC certification, CPC and CRC.
• At least 3 years of experience in risk adjustment coding and/or billing experience required.
• At least 1 year of experience with targeted provider education.
• Reliable transportation/Valid Driver’s License/Must be able to travel up to 75% of work time
• PC skills and experience using Microsoft applications such as Word, Excel, and Outlook
• Excellent presentation, verbal and written communication skills, and ability to collaborate
• Must possess the ability to educate and train provider office staff members
• Proficiency with healthcare coding software and Electronic Health Records (EHR) systems

Skills

Strong billing knowledge and/or Certified Professional Biller (CPB) through APPC, knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage, strong PowerPoint and public speaking experience, Ability to work independently and collaborate in a team setting, Experience with Monday.com, Experience collaborating with, educating, and presenting to provider teams in a face-to-face setting

Benefits

Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.

Pay

The national target pay range for this role is $70,000 - $85,000 per year.

Schedule

This position is remotely based in the U.S. The home office is located at 1600 Corporate Center Dr. Monterey Park, CA 91754.