Medical Risk Adjustment Coder- VBC

Orlando Health; Orlando (FL); On-site; USD 60,000 - 90,000; Full time

Job summary

Orlando Health is seeking a Medical Risk Adjustment Coder to support physician practices and the Care Coordination Department with coding improvement activities. The role involves auditing charts, validating diagnoses for Medicare/Medicare Advantage and ACO members, and ensuring CMS risk adjustment compliance.

Ideal candidates hold CPC and CRC certifications, with at least two years of medical coding experience and proficiency in Windows, Word, Excel, and related tools.

Qualifications

• High School Diploma or equivalent.
• CPC and CRC certifications.
• Minimum two years of medical coding experience with HCC/HHS and Medicare Risk Adjustment.

Responsibilities

• Collaborates with providers and payer representatives to optimize diagnosis code capture.
• Reviews medical records and billing history to ensure accurate coding.
• Ensures compliance with CMS risk adjustment guidelines and documentation standards.
• Supports HEDIS chart reviews and quality measures reporting.

Skills

HCC/HHS experience

Medical coding

Communication skills

Education

CPC and CRC certifications

Tools

Windows

Microsoft Word

PowerPoint

Excel

Job description

About Orlando Health

At Orlando Health, we are ordinary people with extraordinary individuality, working together to bring help, healing and hope to those we serve. By daily embodying our 100‑year legacy, we reinforce our reputation as a trusted and respected healthcare organization that delivers professional and compassionate care to our patients, families and communities. Through our award‑winning hospitals and ERs, specialty institutes, urgent care centers, primary care practices and outpatient facilities, our 27,000+ team members serve communities across Florida’s east to west coasts and beyond.

Position Summary

The Medical Risk Adjustment Coder supports physician practices and the Care Coordination Department with coding improvement activities using various clinical data systems. Orlando Health offers benefits that go beyond the expected, including career‑growth education programs and well‑being services to support you and your family from day one, along with flexibility wherever possible so that you can be present for your passions.

Responsibilities

• Collaborates with a variety of internal and external clients, including health‑care executives, physicians, provider office personnel, and payer representatives from various health plans to streamline and optimize accurate diagnosis code capture.
• Maintains responsibility for conducting clinical chart and patient billing audits for the purpose of
• Identifying and validating reported diagnoses for Medicare/Medicare Advantage and ACO health‑plan members.
• Reviews medical records and billing history to determine if specific disease conditions were correctly billed and documented.
• Adheres to all official coding rules and CMS guidelines for risk adjustment, and ensures accuracy, completeness, specificity and appropriateness of diagnosis information.
• Assists with the completion of HEDIS chart reviews and facilitates the accurate and timely reporting of quality measures.
• Demonstrates analytical and problem‑solving ability in the process of reviewing submitted diagnosis codes, comparing them to the actual services provided to the patient, and communicates appropriate feedback to providers and billing personnel.
• Performs analysis and focused chart reviews for targeted provider education training projects.
• Assists in the acquisition, development and distribution of coding and documentation improvement educational materials.
• Provides articles for the quarterly coding newsletter.
• Facilitates collection, validation, distribution and follow‑through support of monthly and quarterly HCC coding reports for all providers participating in the Managed Medicare Program and Accountable Care Organization Programs.
• Places emphasis on compliance with Risk Adjustment procedures and protocol, internal controls, and maintaining the highest level of workplace behavior.
• Coordinates data collection and aggregation on a variety of focused audits and HCC coding capture projects.
• Validates the results of payer audits and translates findings into educational opportunities and tools to optimize revenue recovery.
• Offers support in the Care Coordination Department, focusing on provider and staff education.
• Facilitates ongoing quality metrics monitoring and assists with providing quarterly quality metrics reports for each PCP.
• Performs data validation and integrity functions in a variety of systems pertaining to patient care, clinical documentation, charge entry & billing, and payer claims management.
• Documents and reports activities regarding program status.
• Reviews, analyzes and modifies data as necessary to meet both internal and external customer needs.
• Works with clinical staff to analyze reports and collaboratively identify improvement opportunities.
• Monitors quality, cost and efficiency on a recurring basis.
• Remains available when needed to attend Managed Medicare meetings, record minutes, and translate meeting outcomes into action plans that yield measurable results.
• Maintains reasonably regular, punctual attendance in accordance with Orlando Health policies, the ADA, FMLA and other federal, state and local standards.
• Maintains compliance with all Orlando Health policies and procedures.

Other Related Functions

• Maintains established work production standards.
• Assumes responsibility for professional growth and development.
• Works independently in a time‑oriented environment.
• Participates in professional healthcare and community associations to stay abreast of current healthcare trends.

Qualifications

Education / Training

• High School Diploma or equivalent.

Licensure / Certification

• Certified Professional Coder (CPC)
• Certified Risk Adjustment Coder (CRC)

Experience

• Prior HCC/HHS experience with Medicare Risk Adjustment and at least two years of medical coding experience.
• Computer literate with skills in Windows, Microsoft Word, PowerPoint and Excel.
• Excellent written and verbal communication skills; able to write concisely and effectively when communicating with providers.