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Role Description

We are looking for a Certified Risk Adjustment Coder who is passionate about supporting accurate and compliant documentation for our PACE participants. This role requires a self-starter who thrives in an independent, remote environment, with strong critical thinking skills and a drive to deliver the highest quality outcomes. The ideal candidate will have hands-on expertise in both CMS-HCC v24 and v28 models and the ability to apply coding standards across multiple workflows.

• Review participant medical records and provider documentation to identify, validate, and code risk-adjustable diagnoses in accordance with CMS-HCC v24 and v28 guidelines.
• Ensure complete, accurate, and compliant ICD-10-CM coding with a primary focus on concurrent and retrospective reviews (with flexibility for pre-visit planning as needed).
• Draft and submit compliant provider queries to clarify documentation and support accurate coding.
• Track and follow through on open queries—engaging with providers, monitoring responses, and closing them out appropriately.
• Apply strong critical thinking skills to resolve complex documentation and coding scenarios.
• Maintain clear, professional communication with providers and internal teams to support documentation completeness.
• Stay current with CMS, OIG, and industry regulations related to risk adjustment and coding compliance.

Qualifications

• Active CRC (Certified Risk Adjustment Coder) required.
• Minimum of 1 year of experience in risk adjustment coding.
• In-depth knowledge of ICD-10-CM and CMS-HCC models v24 and v28.
• Demonstrated ability to work independently, stay organized, and follow through on tasks with minimal oversight.
• Strong written and verbal communication skills, with the ability to engage providers in a professional and solutions-oriented manner.
• High attention to detail and ability to critically analyze clinical documentation.
• Proficiency with electronic health records (EHR) and Microsoft Excel.
• Aligns with our purpose and our values, and is excited about living those out in daily practice.

Requirements

• Experience as a risk adjustment coder in PACE, long-term care, or complex care populations (nice to have).
• Background in clinical documentation improvement (CDI) or coding quality assurance (nice to have).
• Experience with Epic/OCHIN systems (nice to have).

Benefits

• Medical/dental/vision insurance.
• Short and long-term disability.
• Life insurance.
• Flexible spending accounts.
• 401(k) savings.
• Paid time off.
• Company-paid holidays.
• Expected salary range: $24-$27 hourly and is bonus eligible.