Remote CDI & Coding Specialist - HEDIS & Risk Adjustment

Nascentia Health, Inc.; City of Syracuse (NY); Remote; USD 90,000 - 109,000; Full time

Benefits offered by this job

401k with generous Employer match

Tuition Reimbursement for BSN after 6‑

Exceptional work/life balance

Partially funded HSA

Employee Recognition Platform

Paid Time Off, Holidays, and ExtendedS

Short/Long term Disability

Employee Assistance Program (EAP)

Job summary

Nascentia Health, Inc. is seeking a Senior CDI & Coding Specialist to ensure clinical documentation accuracy, support HEDIS quality measures, and strengthen risk adjustment across health plan operations.

You will leverage Inovalon solutions for record retrieval, validation, and workflow development in a remote-first setting. The role collaborates with Quality Improvement, Utilization Management, Clinical Operations, and Provider Relations to identify opportunities for documentation improvement

Qualifications

• Active CPC, CCS, CRC, or equivalent nationally recognized coding certification.
• Minimum 3–5 years of relevant experience in medical coding, clinical documentation improvement, risk adjustment, or clinical data validation.
• Strong knowledge of ICD-10-CM coding guidelines and clinical documentation requirements.
• Experience with Medicare Advantage, Managed Care, or Health Plan operations.
• Working knowledge of HEDIS quality measurement and CMS-HCC risk adjustment methodologies.
• Experience reviewing medical records for coding accuracy and documentation completeness.
• Strong analytical, communication, and problem-solving skills.
• Ability to work independently and collaborate across multiple departments

Responsibilities

• Review medical records to evaluate documentation completeness, clinical specificity, and coding accuracy.
• Validate ICD-10-CM, CPT, CPT II, and HCPCS coding against supporting clinical documentation and applicable coding guidelines.
• Identify missing, inconsistent, or unsupported documentation and recommend compliant clarification or correction.
• Conduct prospective and retrospective coding reviews.
• Support coding audits, documentation improvement initiatives, and regulatory compliance.
• Serve as an internal coding resource for clinical, quality, and operational teams.
• Support HEDIS medical record review, abstraction, and validation activities.
• Identify documentation supporting HEDIS measure compliance and appropriate gap closure.
• Review clinical records for services completed but not accurately represented in available clinical or claims data.
• Evaluate coding opportunities involving CPT II, procedure, and diagnosis codes relevant to quality reporting.
• Support supplemental data validation, medical record audits, and data reconciliation.
• Review medical records to validate risk-adjustable diagnoses and supporting clinical documentation.
• Identify documentation gaps, coding inaccuracies, and opportunities for compliant provider clarification.
• Support CMS-HCC coding accuracy and risk adjustment data integrity.
• Conduct prospective and retrospective risk adjustment reviews.
• Assist with risk adjustment audits, coding validation, and documentation improvement initiatives.
• Collaborate with provider-facing teams to strengthen documentation of chronic and complex conditions.

Skills

Medical coding knowledge

ICD-10-CM guidelines

CMS-HCC risk adjustment

Analytical thinking

Communication

Education

CPC/CCS/CRC certification

Tools

Inovalon solutions

Job description

Nascentia Health, Inc. is seeking a Senior CDI & Coding Specialist to ensure clinical documentation accuracy, support HEDIS quality measures, and strengthen risk adjustment across health plan operations.

You will leverage Inovalon solutions for record retrieval, validation, and workflow development in a remote-first setting. The role collaborates with Quality Improvement, Utilization Management, Clinical Operations, and Provider Relations to identify opportunities for documentation improvement