Medicare Risk Adjustment Specialist I

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🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $25 - $28 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🎲 Risk

🚫👨‍🎓 No degree required

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On Belay Health Solutions

WebsiteLinkedInAll Job Openings

51 - 200 employees

⚕️ Healthcare Insurance

💳 Fintech

💰 $6.5M Venture Round on 2022-03

Healthcare Insurance • Healthcare • Fintech

On Belay Health Solutions is a company that partners with independent primary care practices and Federally Qualified Health Centers to enhance patient outcomes and improve care team experiences. They empower primary care teams to succeed in value-based care by providing the necessary resources, support, and insights for holistic patient management. Their vision is to create a positive healthcare experience for all by strengthening the financial foundation of practices while promoting better health among patients.

📋 Description

• 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!