HCC/RAF Coding Specialist — Hybrid, Risk Adjustment

Baystate Health; Springfield (MA); Híbrido; USD 90.000 - 122.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Competitive Pay

Tuition & Training

Career Growth

Regional Opportunities

Retirement

Paid Time Off

Descripción de la vacante

Baystate Health is seeking an HCC/RAF Coding Specialist to join our Population Health team. The role drives documentation accuracy, quality outcomes, and reimbursement integrity through review of medical records, ICD-10 coding, and risk adjustment activities.

You will support providers, optimize problem lists, and collaborate to improve documentation quality across CMS HCC and MassHealth DxCG guidelines. This hybrid role travels to practices for education and implementation.

Formación

• Associate's degree required.
• Current and active licensure: RN, LPN, MD/DO, or APP.
• Three or more years of RN clinical experience or physician-trained clinical experience.
• Strong clinical knowledge of chronic disease processes and condition management.
• Knowledge of ICD-10 diagnosis coding principles and clinical documentation requirements.
• Understanding of CMS HCC risk adjustment methodology and reimbursement concepts.
• Proficiency with electronic medical records and Microsoft Office applications.
• Excellent written and verbal communication skills.
• Strong organizational, analytical, and problem-solving abilities with the ability to work independently.
• Driver's license required.

Responsabilidades

• Review medical record documentation and abstract ICD-10 diagnosis codes to accurately capture patient complexity, severity of illness, and risk adjustment opportunities.
• Identify, validate, and report missing, incomplete, inaccurate, or unsupported diagnoses in accordance with CMS HCC and coding guidelines.
• Maintain and optimize patient problem lists by adding, updating, or removing diagnosis codes based on current clinical documentation.
• Collaborate with physicians and advanced practice providers to clarify ambiguous or incomplete documentation and ensure coding accuracy.
• Serve as a subject matter expert in HCC, RAF, and risk adjustment coding methodologies.
• Educate providers and staff on documentation improvement opportunities, coding requirements, and risk adjustment best practices.
• Analyze risk adjustment and population health reports to identify trends, educational needs, and reimbursement opportunities.
• Support Medicare Annual Wellness Visit initiatives and other programs that improve patient outcomes, quality measures, and coding accuracy.
• Assist with data collection, reporting, audits, and quality improvement initiatives related to documentation and coding practices.
• Identify and communicate documentation deficiencies, coding concerns, and compliance-related issues.
• Support onboarding activities for new patients to ensure accurate and complete documentation of chronic conditions and health maintenance needs.
• Adhere to all Baystate Health compliance standards, regulatory requirements, and coding guidelines.

Conocimientos

ICD-10 coding knowledge

CMS HCC risk adjustment

Communication skills

EMR proficiency

MS Office proficiency

Educación

Associates Degree

Herramientas

EMR systems

Microsoft Office

Descripción del empleo

Baystate Health is seeking an HCC/RAF Coding Specialist to join our Population Health team. The role drives documentation accuracy, quality outcomes, and reimbursement integrity through review of medical records, ICD-10 coding, and risk adjustment activities.

You will support providers, optimize problem lists, and collaborate to improve documentation quality across CMS HCC and MassHealth DxCG guidelines. This hybrid role travels to practices for education and implementation.