Medicare RAF Specialist: Coding & Risk Analytics

Vivant Health; Sacramento (CA); On-site; USD 70,000 - 100,000; Full time

Job summary

Vivant Health is seeking an RAF Specialist to support Medicare Advantage risk adjustment efforts. You will ensure accurate documentation and coding of diagnoses to optimize RAF scores, collaborating with providers, coders, and care teams. The role emphasizes CMS-HCC compliance, education, and data analysis.

The ideal candidate has 2–3 years in risk adjustment or IPA operations, with CPC/CRC credentials and proficiency in EMR/EHR systems and analytics tools such as Excel and Power BI.

Qualifications

• Requires High School Diploma or GED.
• Associate’s or Bachelor’s degree preferred in HIM/Health Admin/Nursing.
• CPC or CRC certification required.

Responsibilities

• Review clinical documentation and coding for CMS-HCC compliance.
• Monitor RAF score trends across providers and populations.
• Conduct chart reviews to identify coding gaps and opportunities.
• Collaborate with providers to ensure accurate encounter data submission.
• Develop RAF dashboards and support audits related to CMS risk adjustment.
• Educate providers on compliant documentation and coding practices.

Skills

Risk Adjustment

HCC coding

CMS guidelines

ICD-10

EMR/EHR systems

Data analysis

Provider education

Attention to detail

Communication

Excel/Power BI

Cozeva

Education

High School Diploma or GED

Associate’s or Bachelor’s in Health Information Management/Health Admin/Nursing

Certified Professional Coder (CPC) or CRC

Tools

EMR/EHR systems

Cozeva

Risk adjustment analytics platforms

Job description

Vivant Health is seeking an RAF Specialist to support Medicare Advantage risk adjustment efforts. You will ensure accurate documentation and coding of diagnoses to optimize RAF scores, collaborating with providers, coders, and care teams. The role emphasizes CMS-HCC compliance, education, and data analysis.

The ideal candidate has 2–3 years in risk adjustment or IPA operations, with CPC/CRC credentials and proficiency in EMR/EHR systems and analytics tools such as Excel and Power BI.