Medicare Risk Adjustment Specialist I
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Job Description
Medicare Risk Adjustment Coding Specialist supporting AI-driven chart reviews and risk adjustment programs at On Belay Health Solutions. Reviewing and validating coding opportunities, ensuring compliance and accuracy.
Responsibilities:
- Review and validate AI-identified risk adjustment coding opportunities within medical records
- Assess clinical documentation to determine the appropriateness of proposed diagnoses and HCC submissions
- Support the quality assurance process for AI-assisted chart reviews by identifying coding discrepancies, false positives, and missed opportunities
- Develop feedback loop with On Belay’s Head of Risk Adjustment Coding and physician offices On Belay supports, including but not limited to: Identification of quality improvement opportunities in individual physician coding
- Any other related duties assigned at manager’s discretion
Requirements:
- High school diploma or GED required
- Associates degree preferred
- Active coding certificate required
- AAPC or AHIMA coding certification preferred
- Required: CCS-P (Certified Coding Specialist- Physicianbased) or CPC (Certified Professional Coder)
- Preferred: CRC (Certified Risk Adjustment Coder)
- Experience in a primary care setting highly preferred
- Knowledge of medical terminology and medical chart review required
- Two (2) or more years’ experience of hierarchical condition categories (HCC)
- Knowledge of ICD-10-CM Official Guidelines for Coding and Reporting
- Knowledge of AHA Coding Clinic and authoritative coding resources
- Knowledge of Microsoft Office suite, primarily Excel (specifically Pivot Tables, sort and filter functions)
- Strong time management skills required
- Ability to navigate within various EMRs (Electronic Medical Records), Cerner Preferred
- Strong interpersonal, communication (verbal, non-verbal and listening) skills
- Ability to remain productive under time constraints and meet deadlines critical to the business.
Benefits:
- Innovative, revolutionary environment
- Great culture with a strong sense of mission and community
- Eleven (11) Paid Holidays
- Lavish PTO accrual
- Advancement opportunities & professional skills training
- Strong referral bonus program
- And more!
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