Foundcare, Inc.
Description
PRIMARY PURPOSE:
The Risk Adjustment Coder plays a critical role in ensuring accurate documentation and coding of chronic conditions to support value-based care initiatives and optimize risk scores for reimbursement. This position focuses on Hierarchical Condition Categories (HCC), ICD-10 coding, and clinical documentation improvement (CDI) strategies aligned with CMS and HRSA guidelines. The coder collaborates with providers, care teams, and data analysts to support accurate risk stratification and compliance. ESSENTIAL JOB FUNCTIONS:
Review medical records to identify and assign appropriate ICD-10 codes for risk-adjusted conditions using HCC methodology. Ensure coding accuracy and completeness to support Medicare Advantage, ACA, and other risk-based programs. Collaborate with providers to improve documentation of chronic conditions and suspected diagnoses. Conduct retrospective and prospective chart reviews to identify coding opportunities. Monitor coding trends and provide feedback to clinical teams to support documentation improvement. Assist in developing and implementing coding workflows for value-based contracts. Support audit readiness and compliance with CMS, HRSA, and 2 CFR Part 200 regulations. Participate in coding quality assurance initiatives and internal audits. Work with population health and analytics teams to validate risk scores and identify gaps in care. Stay current on coding guidelines, payer updates, and regulatory changes affecting risk adjustment. Perform other duties as assigned. Requirements
REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:
Excellent verbal and written communication skills. Excellent attention to detail and analytical skills. Proficiency in Microsoft Excel, data validation, and reporting tools. Strong knowledge of HCC coding, ICD-10, and CMS risk-adjustment models. Knowledge of COSO Internal Control Framework and 2 CFR Part 200 compliance is preferred. Ability to act with integrity, professionalism, and confidentiality. Ability to work independently and collaboratively across departments. PHYSICAL REQUIREMENTS:
Ability to endure short, intermittent, and/or long periods of sitting and/or standing in performance of job duties. Ability to lift and carry objects weighing 15 pounds or less. Accomplish job duties using various types of equipment/supplies, e.g. pens, pencils, calculators, computer keyboard, telephone, etc. Ability to travel to other FoundCare locations and perform job duties. Ability to travel to other locations to attend meetings, workshops, and seminars, plus travel to other FoundCare departments and FoundCare conference rooms. MINIMUM QUALIFICATIONS:
Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), or equivalent certification required. Minimum of three (3) years of experience in medical coding, with at least two (2) years in risk-adjustment coding. Experience with value-based care programs, including Medicare Advantage and ACOs. Familiarity with EHR systems (e.g., Epic, eClinicalWorks) and coding software. Understanding of clinical workflows and care-coordination models is preferred. Experience in Federally Qualified Health Centers (FQHCs) or HRSA-funded programs is preferred.
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The Risk Adjustment Coder plays a critical role in ensuring accurate documentation and coding of chronic conditions to support value-based care initiatives and optimize risk scores for reimbursement. This position focuses on Hierarchical Condition Categories (HCC), ICD-10 coding, and clinical documentation improvement (CDI) strategies aligned with CMS and HRSA guidelines. The coder collaborates with providers, care teams, and data analysts to support accurate risk stratification and compliance. ESSENTIAL JOB FUNCTIONS:
Review medical records to identify and assign appropriate ICD-10 codes for risk-adjusted conditions using HCC methodology. Ensure coding accuracy and completeness to support Medicare Advantage, ACA, and other risk-based programs. Collaborate with providers to improve documentation of chronic conditions and suspected diagnoses. Conduct retrospective and prospective chart reviews to identify coding opportunities. Monitor coding trends and provide feedback to clinical teams to support documentation improvement. Assist in developing and implementing coding workflows for value-based contracts. Support audit readiness and compliance with CMS, HRSA, and 2 CFR Part 200 regulations. Participate in coding quality assurance initiatives and internal audits. Work with population health and analytics teams to validate risk scores and identify gaps in care. Stay current on coding guidelines, payer updates, and regulatory changes affecting risk adjustment. Perform other duties as assigned. Requirements
REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:
Excellent verbal and written communication skills. Excellent attention to detail and analytical skills. Proficiency in Microsoft Excel, data validation, and reporting tools. Strong knowledge of HCC coding, ICD-10, and CMS risk-adjustment models. Knowledge of COSO Internal Control Framework and 2 CFR Part 200 compliance is preferred. Ability to act with integrity, professionalism, and confidentiality. Ability to work independently and collaboratively across departments. PHYSICAL REQUIREMENTS:
Ability to endure short, intermittent, and/or long periods of sitting and/or standing in performance of job duties. Ability to lift and carry objects weighing 15 pounds or less. Accomplish job duties using various types of equipment/supplies, e.g. pens, pencils, calculators, computer keyboard, telephone, etc. Ability to travel to other FoundCare locations and perform job duties. Ability to travel to other locations to attend meetings, workshops, and seminars, plus travel to other FoundCare departments and FoundCare conference rooms. MINIMUM QUALIFICATIONS:
Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), or equivalent certification required. Minimum of three (3) years of experience in medical coding, with at least two (2) years in risk-adjustment coding. Experience with value-based care programs, including Medicare Advantage and ACOs. Familiarity with EHR systems (e.g., Epic, eClinicalWorks) and coding software. Understanding of clinical workflows and care-coordination models is preferred. Experience in Federally Qualified Health Centers (FQHCs) or HRSA-funded programs is preferred.
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