Senior CMS Risk Adjustment Coder & Educator

Paycom - ATS; Santa Barbara (CA); On-site; USD 44,000 - 61,000; Full time

Job summary

Paycom - ATS is seeking a Risk Adjustment Coder Specialist to ensure accurate medical diagnosis data submission to CMS for CenCal Health Medicare Advantage D-SNP. You will optimize documentation, oversee vendor coding, and educate providers on risk adjustment standards.

The role requires expertise in CMS risk models, ICD-10-CM guidelines, and strong collaboration with clinical and analytics teams to enhance risk adjustment outcomes.

Qualifications

• Expert knowledge of CMS-HCC or HHS-HCC risk adjustment models.
• Strong knowledge of ICD-10-CM guidelines and documentation standards.
• Ability to identify incorrect, missing, or duplicate codes and correct them.
• Experience in identifying documentation gaps and providing provider education.

Responsibilities

• Review records to ensure CMS-HCC coding accuracy.
• Oversee outsourced coding vendor performance and quality.
• Collaborate with provider groups to resolve coding questions.
• Educate providers on CMS risk adjustment guidelines and documentation.

Skills

CMS-HCC mapping

ICD-10-CM coding

HIPAA compliance

Data analysis

Vendor management

Effective communication

Education

Bachelor’s degree in Healthcare Admin/HIM

CPC or CRC certification

Tools

Microsoft Word

PowerPoint

Excel

Outlook

Job description

Paycom - ATS is seeking a Risk Adjustment Coder Specialist to ensure accurate medical diagnosis data submission to CMS for CenCal Health Medicare Advantage D-SNP. You will optimize documentation, oversee vendor coding, and educate providers on risk adjustment standards.

The role requires expertise in CMS risk models, ICD-10-CM guidelines, and strong collaboration with clinical and analytics teams to enhance risk adjustment outcomes.