Medicare Risk Adjustment Coding Specialist - Hybrid

Greater Good Health; El Segundo (CA); Hybrid; USD 90,000 - 130,000; Full time

Benefits offered by this job

Lunch and parking provided every day

Medical, Dental & Vision benefits

401K with company match

Monthly phone/internet reimbursement

Paid time off

Job summary

Greater Good Health is seeking a Risk Adjustment Coding Specialist to own retrospective CDI chart reviews and strengthen coding compliance and risk adjustment optimization in our Medicare-focused primary care model.

Ideal candidates have deep Medicare risk adjustment knowledge, outpatient CDI experience, and can translate complex coding requirements for clinical and revenue teams while collaborating with Revenue Cycle and Clinical Operations.

Qualifications

• Medicare risk adjustment knowledge and CDI understanding.
• Experience with ICD-10-CM coding guidelines and HCC models.
• Ability to translate coding guidance for clinical and revenue teams.

Responsibilities

• Own retrospective CDI chart review for compliant, accurate and optimized coding.
• Design and execute formal coding audits to ensure CPT and diagnosis coding are supported by documentation.
• Identify documentation gaps and compliance concerns; support remediation efforts as needed.
• Partner with Revenue Cycle to support claim corrections, rebilling, and documentation follow-up.
• Assist with coding research for new CPTs and services, including requirements and reimbursement considerations.
• Support resolution of coding and documentation queries with providers to amend documentation.
• Develop coding and documentation education content for nurses and clinical teams based on audit findings.
• Build and maintain CDI worklists and audit trackers in Excel with flags for missed HCCs.

Skills

Medicare risk adjustment

ICD-10-CM knowledge

Communication skills

Education

CRC or equivalent certification

CDI credential preferred (CDIP/CCDS)

Tools

Excel

Job description

Greater Good Health is seeking a Risk Adjustment Coding Specialist to own retrospective CDI chart reviews and strengthen coding compliance and risk adjustment optimization in our Medicare-focused primary care model.

Ideal candidates have deep Medicare risk adjustment knowledge, outpatient CDI experience, and can translate complex coding requirements for clinical and revenue teams while collaborating with Revenue Cycle and Clinical Operations.