Health Risk Adjustment Coder in Riverside, California at Blue Zones Health

You could be the one who changes everything.

Blue Zones Health is on a mission to empower patients, physicians, and communities to Live Better, Longer™ by delivering transformative primary care rooted in lifestyle medicine. Formerly Healthly, we are reimagining healthcare by addressing the root causes of chronic disease and reducing the need for costly interventions. Our approach integrates insights from the original Blue Zones research, over 25 years of scientific study into the world’s longest-lived cultures, and is grounded in the evidence-based methodology of the American College of Lifestyle Medicine.

We serve patients virtually nationwide and in-person through an expanding network of clinic locations, making whole-person care accessible and impactful.

Position Summary

The Health Risk Adjustment Coder plays a vital role on the Blue Zones Health Vitality Medical Team. This individual owns risk adjustment strategy implementation, partner relationships, compliance, and quality performance initiatives related to Medicare Risk Adjustment (MRA). The role focuses on the development and oversight of data-driven programs that support accurate coding, provider engagement, performance improvement, and regulatory compliance.

This is a remote position with local travel required 2–3 times per week to provider practices across the all provider network region.

Key Responsibilities

• Serve as the subject matter expert (SME) and lead initiatives across prospective, retrospective, and concurrent MRA strategies.
• Monitor risk adjustment coding compliance and performance across the organization.
• Guide provider documentation, chart review accuracy, and coding integrity to ensure appropriate HCC recapture.
• Conduct internal education for clinical staff and providers on accurate coding practices and clinical documentation improvement.
• Lead cross-functional collaboration with Finance, Analytics, and the Vitality team to identify coding improvement opportunities and drive data-informed strategies.
• Partner with vendors and payers to oversee coding performance, program integrity, and service level adherence.
• Drive completion of key KPIs, including risk score accuracy, coding quality, and annual wellness visit (AWV) completion rates.
• Support operational leaders and provider engagement teams with workflow integration and training for value-based risk and quality initiatives.
• Support tailored campaign strategies for risk and quality performance improvement based on local market needs and provider group trends.
• Ensure all activities meet federal, state, and partner compliance requirements.
• Provide regular updates and progress reports to senior leadership and key stakeholders.

Compliance:

• Employee shall comply with all applicable federal, state, and local laws, as well as all Employer policies, procedures, and standards, including but not limited to codes of conduct and ethics requirements, as amended from time to time.

Licensure & Certification (one or more required):

• Certified Professional Coder (CPC) – AAPC
• Certified Risk Adjustment Coder (CRC) – AAPC
• Certified Coding Specialist for Providers (CCS-P) – AHIMA
• Registered Health Information Technician (RHIT) – AHIMA

Experience:

• Minimum 2 years in medical operations, specifically within value-based care and risk adjustment coding.
• Demonstrated knowledge of Medicare Advantage, RAF scores, and risk score documentation.
• Prior experience educating providers on correct coding and care gap closure.
• Strong project management and performance tracking skills.

Skills and Competencies

• Proficient in MS Office Suite (Excel, Word, PowerPoint).
• Strong analytical thinking, public speaking, and written communication skills.
• Ability to synthesize data and translate trends into actionable strategies.
• Skilled at building relationships and working cross-functionally.
• Experience presenting coding performance trends to physician groups or leadership.
• Self-directed, detail-oriented, and able to manage multiple priorities effectively.

Working Conditions

• Remote work with local travel to clinics in the All-provider network coverage at least 2–3 days per week. Rotation of clinics will be flexible
• Normal office working conditions with flexibility in scheduling.
• Must have reliable transportation and the ability to travel within the assigned region.