RN HCC/RAF Coding Specialist — Hybrid, Day Shift

Baystate Health; Springfield (MA); Hybrid; USD 90,000 - 122,000; Full time

Benefits offered by this job

Competitive pay and benefits

Tuition assistance and CEUs

Career growth opportunities

Regional opportunities across Baystate

Job summary

Baystate Health is seeking an HCC/RAF Coding Specialist to join the Population Health team in Springfield, MA. You will drive documentation accuracy and reimbursement integrity through ICD-10 coding and risk adjustment activities.

Responsibilities include reviewing records, educating providers, and leveraging CMS HCC guidelines to improve quality measures and population health outcomes across the Baystate Health System. Hybrid work and regional travel for education are involved.

Qualifications

• Associates degree required.
• Current and active licensure as RN, LPN, MD/DO, or APP.
• Three or more years of RN clinical experience or physician-trained clinical experience.
• Knowledge of ICD-10 diagnosis coding principles and clinical documentation requirements.
• Understanding of CMS HCC risk adjustment methodology and reimbursement concepts.
• Proficiency with electronic medical records and Microsoft Office applications.
• Excellent written and verbal communication skills.
• Driver’s license required.

Responsibilities

• Review medical record documentation and abstract ICD-10 diagnosis codes to capture patient complexity and risk.
• Identify, validate, and report missing or unsupported diagnoses per CMS HCC guidelines.
• Maintain and optimize patient problem lists with current documentation.
• Collaborate with physicians and APPs to clarify ambiguous documentation.
• Serve as subject matter expert in HCC, RAF, and risk adjustment coding.
• Educate providers on documentation improvement and coding compliance.
• Analyze risk adjustment and population health reports for trends and opportunities.
• Support Medicare Wellness Visit initiatives and other programs to improve outcomes and coding accuracy.
• Assist with data collection, audits, and quality improvement initiatives.
• Identify documentation deficiencies and compliance issues.

Skills

RN/APP licensure

ICD-10 coding knowledge

CMS HCC risk adjustment

EMR proficiency

Communication skills

Education

Associates degree

Bachelor’s degree preferred

Tools

EMR software

Microsoft Office

Job description

Baystate Health is seeking an HCC/RAF Coding Specialist to join the Population Health team in Springfield, MA. You will drive documentation accuracy and reimbursement integrity through ICD-10 coding and risk adjustment activities.

Responsibilities include reviewing records, educating providers, and leveraging CMS HCC guidelines to improve quality measures and population health outcomes across the Baystate Health System. Hybrid work and regional travel for education are involved.