Remote HCC Coding Analyst & RAF Specialist

Alignment Healthcare USA, LLC; Orange (CA); Remote; USD 58,531 - 87,797; Full time

Job summary

Alignment Health USA, LLC is seeking a Coding Analyst for the Care Delivery Organization to perform HCC coding from member records and support CMS risk adjustment submissions.

You will audit provider documentation, educate clinicians on coding standards, and identify documentation gaps to improve RAF scores across the network. This is a remote role supporting Medicare Advantage operations.

Qualifications

• ICD-10-CM coding performed per official guidelines and CMS risk adjustment rules.
• Knowledge of CMS-HCC model and RAF score impact on plan revenue.
• Ability to review diverse medical records to identify codeable conditions.
• Familiarity with coding audits, compliance, and documentation gaps.
• Experience with EHRs and coding platforms in a high-volume setting.

Responsibilities

• Execute accurate HCC coding from member records using ICD-10-CM.
• Conduct structured provider coding audits for clinician groups.
• Deliver targeted education on coding standards and CMS requirements.
• Identify documentation gaps and communicate findings to providers.
• Ensure CMS guidelines and organizational policies are followed.
• Meet productivity and quality targets for RAF accuracy.
• Stay current on ICD-10-CM updates and risk adjustment changes.
• Support data integrity and downstream risk adjustment reporting.

Skills

ICD-10-CM Coding

HCC Coding

Risk Adjustment

Medical Record Review

Coding Compliance

Audit Readiness

EHR Proficiency

Attention to Detail

CDI Awareness

Education

Health Information Management/Bachelor's

High School Diploma

Job description

Alignment Health USA, LLC is seeking a Coding Analyst for the Care Delivery Organization to perform HCC coding from member records and support CMS risk adjustment submissions.

You will audit provider documentation, educate clinicians on coding standards, and identify documentation gaps to improve RAF scores across the network. This is a remote role supporting Medicare Advantage operations.