Hybrid HCC Risk Adjustment Specialist - Coding & Quality

LMH Health; United States; Hybrid; USD 70,000 - 90,000; Full time

Benefits offered by this job

Hybrid work model

Job summary

LMH Health is seeking a Risk Adjustment Quality Specialist to coordinate and support reviews, education, and chart retrieval for health plan audits. You will translate, input, extract, and validate medical record data using HCC guidelines.

The role supports monitoring quality program performance and works with providers to improve documentation and coding accuracy, with a focus on risk adjustment initiatives.

Qualifications

• Minimum 3 years of experience in medical coding or risk adjustment focusing on HCC and value-based care.
• Strong knowledge of CMS risk adjustment and quality initiatives including HCCs.
• Completion of AHIMA or AAPC credential listed or equivalent.
• Credentialed through AAPC acceptable.

Responsibilities

• Perform comprehensive reviews of patient records to identify coding based on CMS HCC categories.
• Monitor revenue opportunities related to value-based care.
• Manage provider query process to clarify documentation and ensure accuracy of diagnoses.
• Provide education to providers on improving documentation and coding accuracy, specifically HCC.
• Analyze performance data to identify trends and opportunities for improvement.
• Maintain understanding of claims processing, regulations, and Medicare Part D requirements.
• Utilize coding software to ensure compliance with payer requirements.
• Collaborate with medical staff to support accurate coding and reimbursement.
• Participate in audits, quality reviews, and continuous improvement initiatives.

Skills

Medical coding

HCC knowledge

CMS risk adjustment

Audits

Data analysis

Staff education

Communication

Education

AHIMA coding credential

AAPC credential

Health Information Management degree

Tools

3M Coding Solutions

Coding software

Job description

LMH Health is seeking a Risk Adjustment Quality Specialist to coordinate and support reviews, education, and chart retrieval for health plan audits. You will translate, input, extract, and validate medical record data using HCC guidelines.

The role supports monitoring quality program performance and works with providers to improve documentation and coding accuracy, with a focus on risk adjustment initiatives.