Certified Risk Adjustment Coding Specialist

Bluestone Physician Services; Tallahassee (FL); Remote; USD 60,000 - 75,000; Full time

Benefits offered by this job

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

Health Savings Account

Flexible Spending Account (FSA)

Retirement plan with 4% match

Paid holidays

Paid Time Off

Company laptop

Job summary

Bluestone Physician Services is seeking a detail-oriented Certified Risk Adjustment Coding Specialist to conduct thorough chart reviews and accurately capture risk adjustment diagnoses. This remote role requires Florida residency and a CRC or equivalent certification, with 2+ years in healthcare coding focused on HCC.

Responsibilities include reviewing records, assigning ICD-10-CM codes per CMS guidelines, applying MEAT criteria, and identifying documentation gaps.

Qualifications

• Proficient in ICD-10-CM coding guidelines and CMS requirements.
• Experience in risk adjustment coding and HCC capture.
• Ability to review records for documentation gaps and coding opportunities.

Responsibilities

• Review medical records and encounter notes to identify reportable diagnoses.
• Assign accurate ICD-10-CM codes per guidelines and CMS rules.
• Apply MEAT criteria to support diagnosis reporting.
• Identify HCC capture opportunities and gaps in documentation.
• Communicate with providers to clarify and correct records as needed.
• Ensure coding accuracy and clinical support within records.

Skills

ICD-10-CM coding

Risk adjustment

Medical records review

Attention to detail

Remote work capability

HIPAA compliance

Education

Bachelor's degree in Health Information Management

CRC certification or equivalent

Tools

CMS guidelines

Job description

Bluestone delivers great outcomes by bringing exceptional care to patients living with complex, chronic conditions and disabilities. Our unique, robust model of care goes beyond primary care services — our multidisciplinary care teams collaborate with patients, their families and other healthcare providers to deliver care that is preventative, proactive and tailored to their unique needs. Using an evidence-based approach focused on quality care management and data-driven medical decisions, Bluestone care teams collaborate to manage patients’ chronic conditions, address social determinants of health, manage transitions to and from inpatient settings, provide behavioral health support and more. Under our model of care, Bluestone patients experienced 21% fewer ER visits, 36% fewer hospitalizations and 41% fewer hospital readmissions compared to patients with similar conditions and complexities over the same time period. Our care teams travel directly to patients who reside in Assisted Living, Memory Care and Group Home communities throughout Minnesota, Wisconsin and Florida and are supported by clinical operations and administrative colleagues who work remotely or at our corporate offices in Stillwater, Minnesota, and Tampa, Florida. Our success is only possible through the hard work of our employees who bring our core values of Dedication, Excellence, Collaboration and Caring to life every day.

Bluestone has been named to the Star Tribune's Top Workplace list for the 14th year in a row! Bluestone also achieved Top Workplace USA 2021-2026! In 2022, Bluestone Accountable Care Organization (ACO) was the best performing ACO in the country as measured by the overall savings per Medicare beneficiary.

We are seeking a highly motivated and detail-oriented individual to join our team as a Certified Risk Adjustment Coding Specialist. The primary responsibility of this role is to conduct thorough patient chart reviews to identify opportunities for providers to capture risk adjustment diagnostic codes accurately. The successful candidate will play a crucial role in ensuring proper documentation to support appropriate and accurate disease capture and documentation by Bluestone providers. This position offers remote flexibility and the opportunity to make a meaningful impact on documentation accuracy and comprehensive disease capture for Bluestone providers.

Schedule: Full-time, weekdays during regular business hours, no evenings, weekends or holidays. Location: This remote role. MUST be located in one of the Bluestone Markets (Minnesota, Wisconsin or Florida). Salary: $60,000 – $75,000 annual salary. Salary will be commensurate with experience.

Responsibilities

• Review medical records, provider documentation, and encounter notes to identify and validate reportable diagnoses.
• Assign accurate ICD-10-CM diagnosis codes in accordance with official coding guidelines and CMS requirements.
• Apply appropriate MEAT (Monitoring, Evaluation, Assessment, and Treatment) criteria to support diagnosis reporting.
• Review documentation for HCC capture opportunities and identify unsupported, incomplete, or inconsistent diagnoses.
• Identify potential documentation gaps and submit compliant, non-leading provider queries when clarification is needed.
• Evaluate diagnosis coding accuracy and ensure appropriate clinical support exists within the medical record.
• Support prospective and retrospective risk adjustment reviews.
• Perform coding audits and participate in quality improvement initiatives.
• Identify trends in coding discrepancies and communicate opportunities for improvement.
• Collaborate with providers, clinical leadership, billing, coding, and quality departments.
• Maintain current knowledge of CMS regulations, ICD-10-CM guidelines, and changes to risk adjustment models, including applicable HCC model updates.
• Meet established productivity, accuracy, and quality performance standards.
• Maintain confidentiality and comply with HIPAA requirements.

Education/Certification/Experience

Bachelor’s degree in Health Information Management, Nursing, Healthcare Administration, or a related healthcare field is preferred - Candidates without a bachelor’s degree will be considered based on an equivalent combination of relevant education, professional certifications, and extensive hands-on experience in HCC coding, clinical documentation review, and CMS compliance may be considered in place of a formal degree)Certified Risk Adjustment Coder (CRC) certification , Risk Adjustment Coding (RAC) or related risk certification required Minimum of 2 years of experience in healthcare coding, with a focus on Hierarchical Condition Category (HCC) coding and risk adjustment.

Knowledge/Skills/Abilities

Proficiency in reviewing and analyzing medical records for documentation deficiencies and coding opportunities. Strong understanding of ICD-10-CM coding guidelines, particularly as they relate to risk adjustment. Excellent communication skills with the ability to effectively interact with Bluestone providers and clinical staff. Demonstrated experience in providing education and training to Bluestone professionals. Detail-oriented with strong analytical and problem-solving skills. Ability to work independently and manage time effectively in a remote or part-time role. Knowledge of healthcare compliance regulations and privacy laws. Demonstrated compatibility with Bluestone’s mission and operating philosophies. Demonstrated ability to read, write, speak, and understand the English language.

Benefits

Health InsuranceDental InsuranceVision Materials InsuranceCompany paid Life InsuranceCompany paid Short and Long-term DisabilityHealth Savings Account (with employer contribution)Flexible Spending Account (FSA)Retirement plan with 4% matching contributionsTen (10) paid holidays per yearThree weeks (15 Days) Paid Time Off (PTO)Company sponsored laptop and computer accessoriesRegular business hoursPay Transparency$60,000—$75,000 USD