Risk Adjustment Coding Specialist II - REMOTE CST/EST

We are currently seeking a highly motivated Risk Adjustment Coding Specialist to support our Houston market. In this role, you will support risk adjustment efforts by conducting high-volume chart reviews to identify coding gaps, trends, and opportunities for improved accuracy for our providers. You’ll translate your findings into actionable insights, creating and delivering education to providers and practice leaders while navigating complex conversations. Additionally, you’ll track and report on key performance metrics—such as HCC recapture rates, AWVs, and other KPIs, helping drive provider performance and overall program success.

We are seeking candidates who live in CST or EST time zones with strong risk adjustment and provider education experience.

Our Values:

• Put Patients First • Empower Entrepreneurial Provider and Care Teams • Operate with Integrity & Excellence • Be Innovative • Work As One Team

What You'll Do • Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company • Review medical record information on both a retroactive and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC) • Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10- CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines • Interacts with physicians regarding coding, billing, documentation policies, procedures, and conflicting/ambiguous or non-specific documentation • Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing • Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes, Stay informed about changes in Medicare, Medicaid, and private payer requirements. • Provides recommendations to management related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives. • Trains, mentors and supports new employees during the orientation process. Functions as a resource to existing staff for projects and daily work. • Provides peer to peer guidance through informal discussion and overread assignments. Supports coder training and orientation as requested by manager. • May assist or lead projects and/or higher work volume than Risk Adjustment Coding Specialist I • Consistently participate in department and provider meetings with the camera on to promote effective communication, enhance team collaboration, and maintain a strong professional presence in both internal and external interactions. • Other duties as assigned