Coder

Green Key Resources; Nanuet (NY); On-site; USD 90,000 - 130,000; Full time

Job summary

Green Key Resources seeks a Coder/CDI Specialist focused on Medicare members to lead risk adjustment coding quality and education. The role requires expertise in HCC, RAF methodology, and CMS risk guidance, with the ability to mentor the coding team and coordinate with providers on documentation gaps.

The successful candidate will audit outputs, conduct second-level reviews, and drive solutions to improve accuracy and utilization, while acting as a senior-level resource for complex coding

Qualifications

• Medicare Advantage / Managed Care experience required.
• 3 years of Managed Care experience preferred.
• Strong knowledge of HCC, RAF methodology, and CMS risk adjustment guidelines.
• Experience communicating directly with physicians and clinical teams.
• Ability to identify coding and documentation gaps and recommend solutions.
• Dual-eligible or FIDE-SNP experience is a plus.

Responsibilities

• Audit and QC coding team output for accuracy and compliance with HCC/ICD-10-CM guidelines.
• Conduct second-level reviews and serve as an escalation point for complex charts and coding questions.
• Identify documentation gaps and communicate directly with providers regarding documentation queries.
• Educate physicians and clinical teams on documentation practices that support accurate risk adjustment coding.
• Track coding errors, trends, and quality patterns and report findings.
• Identify opportunities related to over/under-utilization and collaborate with teams and provider groups on solutions.
• Support development of processes around right-coding, appropriate utilization, and closing care gaps.
• Work independently as a senior-level coding and auditing resource.

Skills

Medicare Advantage/Managed Care

3 years Managed Care

HCC/RAF knowledge

Physician/clinical team communication

Identify coding/documentation gaps

Dual-eligible/FIDE-SNP experience

Job description

A small managed care company is looking for a Coder/CDI Specialist to focus on Medicare members.

Risk adjustment coding professional who has strong knowledge of HCC, RAF methodology, and CMS risk adjustment guidelines and is comfortable serving as a senior-level resource for coding quality and provider education.

Key Responsibilities

• Audit and perform QC of coding team output for accuracy and compliance with HCC/ICD-10-CM guidelines
• Conduct second-level reviews and serve as an escalation point for complex charts and coding questions
• Identify documentation gaps and communicate directly with providers regarding documentation queries
• Educate physicians and clinical teams on documentation practices that support accurate risk adjustment coding
• Track coding errors, trends, and quality patterns and report findings
• Identify opportunities related to over/under-utilization and collaborate with teams and provider groups on solutions
• Support development of processes around right-coding, appropriate utilization, and closing care gaps
• Work independently as a senior-level coding and auditing resource

Requirements

• Medicare Advantage / Managed Care experience required
• 3 years of Managed Care experience preferred
• Strong knowledge of HCC hierarchy, RAF methodology, and CMS risk adjustment guidelines
• Experience communicating directly with physicians and clinical teams
• Ability to identify coding and documentation gaps and recommend solutions
• Dual-eligible or FIDE-SNP experience is a plus