EHR & Risk-Adjustment Transformation Specialist

Palm Beach Accountable Care Organization, LLC; Houston (TX); On-site; USD 65,000 - 90,000; Full time

Job summary

Palm Beach Accountable Care Organization, LLC seeks a detail-oriented Medical Coder/Risk Adjustment Specialist in the Houston area to optimize coding accuracy and support quality initiatives. You will work closely with physicians and office staff to align documentation with risk adjustment requirements and payer guidelines.

The role emphasizes training, data analysis in Excel, and adherence to HIPAA and regulatory standards, with opportunities to improve reimbursement under MA and related

Qualifications

• High school diploma or GED or related experience.
• Certified coder with MA plans or insurance experience.
• Spanish is a plus.
• MS Office Productivity Tools (Word, Excel, Outlook, PowerPoint); Eclinical Works, Athena or other practice management systems.

Responsibilities

• Manage established physician network for business development and plan/execute healthcare network strategy.
• Consult with physician offices to develop training curriculum for client processes and workflow; map data to new EHR system.
• Review provider documentation to ensure E/M levels are accurate and that ICD-10-CM guidelines are followed.
• Identify risk adjustment opportunities and quality gaps to support cost savings for contracted health plans.
• Provide guidance to staff on coding and billing procedures; assist with training and audits as needed.
• Perform daily reporting and analytics in Excel (pivot tables, trend analysis) to monitor client performance.

Skills

CPC certified

Medical coding

Excel

EHR systems

HIPAA compliance

Communication skills

Education

High school diploma or GED

Certified coder (MA plans/insurance)

Tools

MS Office

Eclinical Works

Athena

Job description

Palm Beach Accountable Care Organization, LLC seeks a detail-oriented Medical Coder/Risk Adjustment Specialist in the Houston area to optimize coding accuracy and support quality initiatives. You will work closely with physicians and office staff to align documentation with risk adjustment requirements and payer guidelines.

The role emphasizes training, data analysis in Excel, and adherence to HIPAA and regulatory standards, with opportunities to improve reimbursement under MA and related