Risk Adjustment Analyst

Physician-Care-Centers-1; Piedmont (SC); Hybrid; USD 60,000 - 65,000; Full time

Benefits offered by this job

Health Insurance

Paid Time Off

401(k) with Company Match

Professional Development Opportunities

Remote Work Flexibility

Job summary

PCC Medical Holdings is seeking an experienced Certified Risk Adjustment Coder to support our primary care practices. The ideal candidate will review medical records, validate diagnoses, and ensure accurate CMS-HCC based coding to support value-based care and appropriate reimbursement.

You will collaborate with providers and care teams, educate staff on coding requirements, monitor coding trends, and participate in quality improvement projects to enhance documentation and risk scores across

Qualifications

• Certified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC) certification or equivalent.
• Minimum of 2 years of risk adjustment coding experience.
• Knowledge of CMS-HCC Risk Adjustment Model and ICD-10-CM Coding Guidelines.
• Familiarity with Medicare Advantage Programs and medical terminology/anatomy.
• Experience reviewing primary care medical records.
• Proficiency with electronic health record (EHR) systems.
• Strong analytical and communication skills.

Responsibilities

• Review medical records to identify opportunities for accurate risk adjustment coding and documentation.
• Perform prospective and retrospective chart reviews to ensure CMS-HCC and payer guidelines compliance.
• Validate chronic conditions and documentation requirements.
• Collaborate with primary care physicians and care teams to clarify diagnoses.
• Educate providers on risk adjustment coding requirements and best practices.
• Monitor coding trends and quality metrics; improve coding accuracy.
• Assist in closing care gaps and supporting value-based care initiatives.
• Conduct coding audits and prepare findings for leadership review.
• Maintain compliance with Medicare Advantage and regulatory requirements.
• Participate in quality improvement projects related to documentation and coding performance.

Skills

Analytical thinking

Communication skills

Education

Bachelor's degree in Health Information Management / Healthcare Administration

Tools

EHR systems

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Admin FullTime Florida, North Palm Beach, FL, US

Salary Range: $60,000.00 To $65,000.00 Annually

Location: Remote/Hybrid - ONLY STATES FLORIDA, GEORGIA, SOUTH CAROLINA, TEXAS
Department: Primary Care
Reports To: Director of Risk Adjustment / Population Health Manager

Position Summary

The Certified Risk Adjustment Coder is responsible for reviewing medical records, identifying and validating diagnoses, and ensuring accurate risk adjustment coding in accordance with CMS-HCC guidelines. This role partners closely with primary care providers, clinical staff, and leadership to improve documentation accuracy, support value-based care initiatives, and ensure appropriate reimbursement for patient populations.

Essential Duties and Responsibilities

• Review medical records to identify opportunities for accurate risk adjustment coding and documentation.
• Perform prospective and retrospective chart reviews to ensure compliance with CMS-HCC, ICD-10-CM, and payer-specific guidelines.
• Validate chronic conditions, disease burden, and documentation requirements.
• Collaborate with primary care physicians, nurse practitioners, and care teams to clarify diagnoses and improve documentation practices.
• Educate providers on risk adjustment coding requirements and best practices.
• Monitor coding trends, quality metrics, and coding accuracy.
• Assist in closing care gaps and supporting value-based care initiatives.
• Conduct coding audits and prepare findings for leadership review.
• Maintain compliance with Medicare Advantage, commercial payer, and regulatory requirements.
• Participate in quality improvement projects relating to documentation and coding performance.

Qualifications

Required

• Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), or equivalent coding certification.
• Minimum of 2 years of risk adjustment coding experience.
• Strong understanding of:
  • CMS-HCC Risk Adjustment Model
  • ICD-10-CM Coding Guidelines
  • Medicare Advantage Programs
  • Medical Terminology and Anatomy
• Experience reviewing primary care medical records.
• Proficiency with electronic health record (EHR) systems.
• Strong analytical and communication skills.

Preferred

• Experience in Value-Based Care or Population Health.
• Experience working with Medicare Advantage populations.
• Knowledge of quality programs such as HEDIS and STAR Ratings.
• Bachelor's degree in Health Information Management, Healthcare Administration, or related field.

Physical Requirements

• Prolonged periods of sitting and computer use.
• Ability to review electronic medical records and reports for extended periods.
• Health, Dental, and Vision Insurance
• Paid Time Off
• 401(k) with Company Match
• Professional Development Opportunities
• Remote Work Flexibility (if applicable)

Preferred Job Posting Summary

PCC Medical Holdings is seeking an experienced Certified Risk Adjustment Coder to support our primary care practices. The ideal candidate will have extensive knowledge of CMS-HCC risk adjustment methodologies, ICD-10 coding, and Medicare Advantage programs. This individual will work closely with providers and clinical staff to ensure accurate documentation and coding, improve risk score accuracy, and support value-based care initiatives across our patient population. Strong analytical skills, coding certification, and healthcare experience are required.