Medicare Risk Adjustment Specialist I

This is a fully remote position, open to applicants in Massachusetts.

📋 Description

• Review and validate AI-detected risk adjustment coding opportunities within medical records.

• Evaluate clinical documentation to assess the validity of proposed diagnoses and HCC submissions.

• Assist in the quality assurance process for AI-supported chart reviews by identifying coding discrepancies, false positives, and overlooked opportunities.

• Establish a feedback loop with On Belay’s Head of Risk Adjustment Coding and affiliated physician offices, including but not limited to: identifying quality improvement opportunities in individual physician coding.

• Perform any other related tasks as assigned at the manager’s discretion.

⛳️ Requirements

• High school diploma or GED is mandatory.

• An associate's degree is preferred.

• An active coding certificate is required.

• AAPC or AHIMA coding certification is preferred.

• Required certifications include CCS-P (Certified Coding Specialist- Physician-based) or CPC (Certified Professional Coder).

• Preferred certification includes CRC (Certified Risk Adjustment Coder).

• Experience in a primary care environment is highly preferred.

• Knowledge of medical terminology and medical chart review is required.

• A minimum of two (2) years’ experience with hierarchical condition categories (HCC) is necessary.

• Familiarity with ICD-10-CM Official Guidelines for Coding and Reporting is essential.

• Knowledge of AHA Coding Clinics and other authoritative coding resources is required.

• Proficiency in Microsoft Office suite, particularly Excel (with specific skills in Pivot Tables, sorting, and filtering functions) is required.

• Strong time management abilities are essential.

• Capability to navigate various EMRs (Electronic Medical Records), with a preference for Cerner.

• Excellent interpersonal and communication skills (verbal, non-verbal, and listening) are necessary.

• Ability to maintain productivity under time constraints and meet critical business deadlines is essential.

🏝️ Benefits

• Innovative and groundbreaking work environment.

• A great culture with a strong sense of mission and community.

• Eleven (11) Paid Holidays.

• Generous PTO accrual.

• Opportunities for advancement and professional skills training.

• Robust referral bonus program.

• And much more!