Remote Risk Adjustment Coder: HCC & Coding Expert

Palm Beach Accountable Care Organization, LLC; Town of Florida (NY); On-site; USD 60,000 - 90,000; Full time

Job summary

Palm Beach Accountable Care Organization, LLC seeks a Risk Adjustment Coder to complete patient assessment forms through electronic and payer portal workflows, support retrospective risk sweeps, and ensure accurate, compliant coding to improve RAF accuracy and revenue integrity across assigned populations.

You will review medical records, manage payer portal queues, collaborate with physicians and staff, and apply CMS ICD-10-CM guidelines.

Qualifications

• Minimum 2 years of professional coding experience with risk adjustment.
• CRC, CPC, CCS or equivalent certification required within 18 months of hire.
• Experience with Medicare Advantage, ACA risk adjustment, value-based care preferred.
• Knowledge of HCC models and compliant documentation and coding standards.

Responsibilities

• Complete patient assessment forms accurately through electronic systems and payer portal workflows.
• Manage payer portal queues, case intake, form completion, submission, and follow-up.
• Support retrospective risk sweep processes with payers and ensure deadlines are met.
• Conduct retrospective documentation reviews to validate diagnosis capture and compliance.
• Perform chart reviews to identify documentation gaps and opportunities for recapture and greater coding specificity.
• Apply current risk adjustment coding guidance and elevate complex issues as needed.
• Maintain audit trails and documentation of review outcomes and submissions.
• Assist with physician and practice education on risk adjustment documentation and coding expectations.

Skills

HCC methodologies

ICD-10-CM coding

Payer portal navigation

Medical-record review

Documentation accuracy

CMS risk adjustment rules

Education

CRC

CPC

CCS

Associate degree preferred

Job description

Palm Beach Accountable Care Organization, LLC seeks a Risk Adjustment Coder to complete patient assessment forms through electronic and payer portal workflows, support retrospective risk sweeps, and ensure accurate, compliant coding to improve RAF accuracy and revenue integrity across assigned populations.

You will review medical records, manage payer portal queues, collaborate with physicians and staff, and apply CMS ICD-10-CM guidelines.