Senior Risk Adjustment Coder: Audit Lead & Educator

Palm Beach Accountable Care Organization, LLC; Town of Florida (NY); On-site; USD 85,000 - 110,000; Full time

Job summary

Palm Beach Accountable Care Organization, LLC seeks a Senior Risk Adjustment Coder to lead retrospective audits, two-sided chart reviews, and education efforts with physicians and practice staff to improve RAF accuracy and compliance.

You will review records for CMS/ICD-10-CM alignment, develop provider education on HCC capture, support PCP onboarding, and collaborate with PES and operations to raise coding quality and program performance.

Qualifications

• Minimum 4+ years of risk adjustment coding and/or auditing experience.
• CRC, CPC, or CDEO certification required; multiple certifications preferred.
• Bachelor’s degree preferred; Medicare Advantage/value-based care experience preferred.

Responsibilities

• Conduct retrospective documentation audits to validate diagnosis capture and compliance.
• Perform two-sided chart reviews to identify documentation gaps and recapture opportunities.
• Evaluate records for complete support of submitted diagnoses.
• Develop and deliver physician education on documentation integrity and HCC guidance.
• Support PCP onboarding with education and guidance on risk adjustment coding.
• Provide ongoing education to PCPs and practice teams based on audit trends.
• Track audit outcomes and report findings to improve coding accuracy.
• Serve as SME on PBACO risk adjustment tools and pre-visit/concurrent capabilities.
• Collaborate with PES department to drive risk adjustment improvements.

Skills

HCC methodology

Audit complex records

Provider education

Communication skills

Organizational skills

MS Office (Excel/PowerPoint)

Education

CRC/CPC/CDEO certifications

Bachelor’s degree preferred

Tools

EHR systems

Coding tools

Audit workflows

Job description

Palm Beach Accountable Care Organization, LLC seeks a Senior Risk Adjustment Coder to lead retrospective audits, two-sided chart reviews, and education efforts with physicians and practice staff to improve RAF accuracy and compliance.

You will review records for CMS/ICD-10-CM alignment, develop provider education on HCC capture, support PCP onboarding, and collaborate with PES and operations to raise coding quality and program performance.