Clinical Risk & Coding Lead for ACO Programs

Provider Partners Health Plan; United States; Remote; USD 90,000 - 125,000; Full time

Job summary

Provider Partners Health Plan is seeking an ACO Coding Manager to lead risk adjustment coding, clinical documentation integrity, and medical record auditing across MSSP, ACO REACH, LEAD, and related programs.

The role partners with Clinical Operations, Quality, Analytics, and Provider Engagement to educate providers, analyze data, and strengthen risk adjustment performance while supporting value‑based care initiatives.

Qualifications

• Current coding certification (CPC, CCS, CCS-P, CRC, or equivalent).
• 3-5 years of coding, risk adjustment, auditing, or related healthcare experience.
• Experience with Medicare HCC coding, RAF methodologies, and clinical documentation review.
• Strong knowledge of ICD-10-CM coding guidelines and CMS documentation requirements.
• Experience conducting medical record audits and communicating findings to providers.
• Understanding of clinical validation, RADV principles, and audit methodologies.
• Experience analyzing claims, EHR, encounter, or risk adjustment data.
• Strong analytical, communication, presentation, and provider education skills.
• Proficiency with Microsoft Excel and healthcare reporting or analytics tools.

Responsibilities

• Analyze claims, encounter, clinical, and coding data to identify HCC, RAF, documentation, and risk adjustment opportunities.
• Monitor coding performance, suspect conditions, recapture rates, disease burden trends, and provider variation.
• Conduct provider-, practice-, and ACO-level analyses to identify opportunities for improvement.
• Translate coding and risk adjustment findings into actionable recommendations for providers and operational leaders.
• Partner with analytics teams to support coding dashboards, reporting, and performance measurement.
• Maintain knowledge of CMS-HCC methodologies and annual model updates.

Skills

Risk adjustment coding

Medical record auditing

Provider education

Data analysis

Healthcare analytics

Education

Certified Professional Coder (CPC)

CCS/CCS-P or CRC

Tools

Microsoft Excel

Healthcare reporting tools

Job description

Provider Partners Health Plan is seeking an ACO Coding Manager to lead risk adjustment coding, clinical documentation integrity, and medical record auditing across MSSP, ACO REACH, LEAD, and related programs.

The role partners with Clinical Operations, Quality, Analytics, and Provider Engagement to educate providers, analyze data, and strengthen risk adjustment performance while supporting value‑based care initiatives.