Senior Risk Adjustment Coder (Remote) in Palm Springs, Florida at PBACO Holding LLC

Measurable Goals/Objectives:

Achieve target audit completion volumes and turnaround times for retrospective and two-sided chart reviewsImprove HCC recapture and documentation specificity through provider education and targeted audit feedbackMaintain compliance with applicable risk adjustment coding, documentation, and audit requirements across assigned programsIncrease provider engagement and education completion for new PCP onboarding and ongoing documentation improvement efforts

Supervisory Responsibilities:

No direct supervisory responsibilities

Competencies: To perform the job successfully, an individual should demonstrate the following competencies:

Strong knowledge of HCC methodology including CMS-HCC, HHS-HCC, CDP logics; ICD-10-CM coding guidelines, CMS risk adjustment requirements, and compliant documentation standardsAbility to audit complex medical records, identify documentation gaps, and apply coding guidance accurately and consistentlyExcellent communication and education skills with the ability to present audit findings and documentation guidance to physicians and practice staffStrong organizational skills and the ability to manage multiple audits, education initiatives, and deadlines in a fast-paced environmentProficiency with EHR systems, coding tools, audit workflows, and Microsoft Office applications, especially Excel and PowerPoint

Safety and Security - Uses equipment and materials properly.Attendance/Punctuality - Is consistently at work and on time.Knowledge of medical records work procedures.Knowledge of computer applications. Knowledge of medical terminology.Knowledge of legal and ethical consideration related to patient information.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience:

Deep knowledge of HCC models, CMS risk adjustment principles, and compliant documentation and coding standards. Minimum 4+ years of risk adjustment coding and/or auditing experience required, including provider-facing education responsibilities. CRC, CPC, or CDEO certification required; multiple certifications preferred. Bachelor’s degree preferred. Experience in Medicare Advantage, value-based care, managed care, and/or provider education is strongly preferred.