Certified Risk Adjustment Coding Specialist

Bluestone Physician Services; Wisconsin; Remote; USD 60,000 - 75,000; Full time

Benefits offered by this job

Health Insurance

Disability insurance (short and long‑t

Health Savings Account (HSA)

Flexible Spending Account (FSA)

Retirement plan with 4% matching

10 paid holidays

Company sponsored laptop

Regular business hours

Job summary

Bluestone Physician Services is seeking a detail‑oriented Certified Risk Adjustment Coding Specialist to conduct thorough patient chart reviews and identify opportunities for accurate risk adjustment coding. The role emphasizes proper documentation and CMS compliance while supporting providers across remote settings.

The position offers full‑time hours, remote flexibility within Bluestone markets, and a salary range of $60,000–$75,000, commensurate with experience, with benefits including health

Qualifications

• Bachelor's degree preferred; equivalent experience may be considered.
• Minimum of 2 years healthcare coding experience with HCC focus.
• Strong knowledge of ICD-10-CM guidelines for risk adjustment.
• Experience reviewing medical records for documentation deficiencies and coding opportunities.
• Familiarity with CMS requirements and HCC model updates.
• Ability to work remotely with excellent time management.

Responsibilities

• Review medical records to identify and validate reportable diagnoses.
• Assign accurate ICD-10-CM codes per guidelines and CMS requirements.
• Apply MEAT criteria to support diagnosis reporting.
• Identify documentation gaps and submit compliant queries when needed.
• Evaluate coding accuracy and ensure clinical support exists.
• Support risk adjustment reviews (prospective and retrospective).
• Conduct coding audits and participate in quality initiatives.
• Collaborate with providers, leadership, billing, and quality teams.

Skills

HCC coding

ICD-10-CM guidelines

Communication skills

Detail-oriented

Remote work ability

Documentation review

English proficiency

Education

Bachelor’s degree in Health Information Management, Nursing, Healthcare Administration, or related field

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. If you are passionate about improving coding practices and ensuring quality patient care, we encourage you to apply!

Schedule: Full-time, weekdays during regular business hours, no evenings, weekends or holidays.

Location: This remote roleMUSTbe 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.

Qualifications:

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)
• 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 Bluestoneproviders and clinical staff.
• Demonstrated experience in providing education and training to Bluestoneprofessionals.
• 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

Bluestone Benefits:

• Health Insurance
• Company paid Short and Long‑term Disability
• Health Savings Account (with employer contribution)
• Flexible Spending Account (FSA)
• Retirement plan with 4% matching contributions
• Ten (10) paid holidays per year
• Company sponsored laptop and computer accessories
• Regular business hours

Pay Transparency

$60,000 - $75,000 USD

For government reporting purposes, we ask candidates to respond to the below self‑identification survey.Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiringprocess or thereafter. Any information that you do provide will be recorded and maintained in aconfidential file.

As set forth in Bluestone Physician Services’s Equal Employment Opportunity policy,we do not discriminate on the basis of any protected group status under any applicable law.