Senior Coding Analyst, Risk Adjustment

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

📋 Description

• Review, audit, and code medical records for HCC reimbursement, training, education, and compliance purposes.

• Achieve daily productivity goals related to HCC coding with an accuracy rate of 95%.

• Conduct outreach and educational initiatives within the office.

• Audit and assess medical documentation to ensure proper ICD-10 and HCC coding and documentation.

• Communicate with physicians when code assignments lack clarity or complexity.

• Annually review HCC and ICD-10 codes for accuracy and implement necessary changes.

• Assist physicians and providers with inquiries and challenges regarding HCC coding and documentation.

• Support HCC coding audits, including IDV, RADV, OIG, and DMHC audits.

• Provide analytics, education, and training to provider offices.

• Act as the subject matter expert for HCC coding initiatives, policies, procedures, guidelines, and compliance standards.

• Be a resource for team members and physician offices.

• Engage with physicians, the provider network, and internal stakeholders.

• Work on both ad hoc and long-term projects assigned by Clinical Performance leadership.

• Support Medicare Advantage risk adjustment and data validation programs, with potential expansion into Commercial, Medicaid, Quality, and SDoH capture.

• Allocate 50% or more of working time to meet production standards.

⛳️ Requirements

• High school diploma or GED along with at least 2 years of relevant HCC coding experience.

• 3–5 years of experience holding professional medical coding credentials (CPC, CRC, or similar).

• 3–5 years of experience in HCC coding and auditing, including chart reviews.

• At least 1 year of experience with EPIC EMR software.

• 3–5 years of experience in Medicare Risk Adjustment.

• A minimum of 1 year of project management experience or coordinating detailed projects or activities.

• Preferred: Bachelor’s degree from an accredited institution.

• Preferred: 6 or more years of experience in a clinic setting, working closely with physicians and staff.

• Preferred: 6 or more years of experience and knowledge regarding Commercial and Medicaid coding, as well as SDOH.

• External hires must successfully pass a background check and drug screening.

• Must consistently meet a 95% accuracy rate in HCC coding and daily productivity targets.

🏝️ Benefits

• Comprehensive medical, vision, and dental coverage.

• 401k savings plan with a company matching contribution.

• Flexible time-off policy.

• 9 paid holidays throughout the year.

• Competitive compensation package.

• Background check and drug screening required for external hires.