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

Measurable Goals/Objectives:

Meet assigned patient assessment form volume, accuracy, and turnaround-time targetsComplete payer portal submissions and required follow-up within payer and organizational deadlinesMaintain established standards for coding accuracy, documentation quality, submission completeness, and audit complianceComplete assigned retrospective payer risk sweep work accurately and within defined campaign timelinesMaintain accurate status tracking and timely resolution or escalation of incomplete, rejected, or returned submissions

Supervisory Responsibilities:

No direct supervisory responsibilities

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

Working knowledge of HCC methodologies, including CMS-HCC, HHS-HCC, and CDP logic; ICD-10-CM coding guidelines; CMS and payer risk adjustment requirements; and compliant documentation standardsAbility to accurately complete patient assessment forms from medical-record documentation and follow payer-specific submission requirementsAbility to navigate multiple electronic systems and payer portals, manage work queues, track submission status, and resolve or escalate workflow exceptionsAbility to review medical records, identify documentation gaps, and apply coding guidance accurately and consistently during retrospective risk sweep activitiesClear written and verbal communication skills for coordinating with physicians, practice staff, operational teams, and payer-facing stakeholdersStrong organizational skills and the ability to manage concurrent payer workflows, assigned reviews, deadlines, and detailed audit trails in a fast-paced environment

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:

Knowledge of HCC models, risk adjustment principles, and compliant documentation and coding standards. Minimum 2 years of professional coding experience required, with risk adjustment, coding audit, medical-record review, patient assessment form completion, payer portal workflows, or retrospective payer risk sweep experience preferred. CRC, CPC, CCS, or an equivalent nationally recognized coding certification required within 18 months of hire. Associate degree or completion of an accredited coding program preferred. Experience in Medicare Advantage, ACA commercial risk adjustment, value-based care, managed care, and/or provider education is preferred.