Risk Adjustment Coding Specialist

Risk Adjustment Coding Specialist

Greater Good Health is a fast-growing organization delivering care to older adults in access starved communities. Our innovative model is led by Nurse Practitioners and focused on outcomes, not volume—meaning we prioritize quality over quantity, spend more time with our patients, and are accountable for their health and well-being. Whether through our own senior-focused primary care clinics or our suite of integrated clinical solutions for health plans and provider groups, we are making value-based care more accessible and more effective. We help reduce avoidable healthcare costs, improve clinical outcomes, and create a best-in-class patient experience. If you're passionate about transforming healthcare and delivering meaningful care to those who need it most, Greater Good Health offers a purpose-driven, collaborative, and supportive environment where your work can make a lasting impact.

We are looking for a Risk Adjustment Coding Specialist to own retrospective CDI chart review and strengthen coding compliance, documentation accuracy, and risk adjustment optimization across our Medicare-focused primary care model. The ideal candidate brings deep expertise in Medicare risk adjustment, a strong understanding of outpatient clinical documentation, and the ability to translate complex coding requirements into practical guidance for clinical and revenue teams. This role will work closely with leaders across Revenue Cycle, Clinical Operations & Clinical Performance to drive compliant, accurate, and optimized coding—resolving documentation and coding queries, closing retrospective review backlogs against CMS filing deadlines, and identifying opportunities to improve risk capture while reducing audit risk. The ability to communicate clearly with both clinical and non-clinical stakeholders is essential. This role will ensure coding accuracy and consistency by helping design and formalize coding audit processes, documentation standards, and education materials. You will review charts, support query resolution, and provide insights into coding trends and regulatory changes that impact our operations. The right person for this role will apply their extensive knowledge of Medicare risk adjustment coding to real-world clinical workflows, balancing compliance, operational efficiency, and scalability. This role offers meaningful autonomy, a focused but impactful scope, and the opportunity to directly strengthen our coding and compliance foundation as we continue to grow.

Responsibilities

• Own retrospective CDI chart review for compliant, accurate and optimized coding
• Design and execute formal coding audits to ensure CPT and diagnosis coding are compliant and fully supported by clinical documentation
• Identify documentation gaps, education opportunities, and compliance concerns; support escalation and remediation efforts as needed
• Partner with Revenue Cycle to support claim corrections, rebilling, and documentation follow-up
• Assist with coding research for new or evolving CPTs and services, including documentation and billing requirements and Medicare reimbursement considerations
• Support resolution of coding and documentation queries, collaborating with providers to amend documentation where appropriate
• Develop coding and documentation education content for Nurse Practitioners and clinical teams, informed by audit findings and recurring themes
• Build and maintain CDI worklists and audit trackers in Excel, including formula-driven flags for missed HCCs, recapture opportunities, and documentation gaps
• Translate chart audit findings into structured Excel-based reporting (trend summaries, provider-level scorecards) for Revenue Cycle and Clinical Operations leadership
• Support Care Services leadership with open condition management and risk adjustment workflows, including coaching and training as needed
• Monitor and report on changes in the coding and risk adjustment landscape, including new, revised, or retired codes and regulatory guidance
• Help formalize coding-related processes and documentation suitable for internal policies and compliance reference

Qualifications

Credentials & Certifications

• Certified Risk Adjustment Coder (CRC or equivalent) required
• CDI credential preferred (CDIP, CCDS, or equivalent) in addition to CRC

Clinical & Coding Experience

• Medicare risk adjustment experience required
• Demonstrated Clinical Documentation Improvement (CDI) experience, including query construction, provider education, and documentation gap remediation
• Strong knowledge of ICD-10-CM coding guidelines, HCC models, and Medicare documentation requirements
• Experience in outpatient clinic and/or primary care settings
• Value-Based Care (VBC) experience
• Experience supporting or participating in coding audits or compliance reviews preferred

Technical Skills

• Proficiency in Excel, including pivot tables, VLOOKUP/XLOOKUP, conditional formatting, and data validation, for chart audit tracking and trend reporting
• Experience building or maintaining audit worklists/trackers in Excel

Communication & Collaboration

• Strong communication skills with the ability to translate coding guidance for clinical, operational, and finance stakeholders
• Comfortable training and coaching providers on documentation and coding best practices, including delivering feedback on individual query patterns

What Will Make You Successful at GGH

• If you "bring it" every day and are continually hungry to learn, share, and tackle challenges.
• You thrive in an environment that champions learning, growth, agency, and autonomy. We support each team member to work at the "top of their license" and find fulfillment in their work.
• We can trust that your words and actions align. We own our mistakes and share our learning with others. We think and act with consideration for people, time, rules, resources, ethics, and GGH's success.

Perks and Benefits

Lunch and parking provided every day in office!

• Competitive Compensation Package: We offer a competitive compensation package to recognize your valuable contributions and ensure your financial security.
• Comprehensive Medical, Dental, and Vision Benefits: Take advantage of comprehensive healthcare coverage, including medical, dental, and vision benefits, to prioritize your health and well-being. Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) available.
• Paid Time Off: Enjoy paid holidays, vacation time, and paid parental leave to maintain a healthy work-life balance and spend quality time with your loved ones.
• 401K Program with Company Match: Plan for your future with our 401K program, featuring a company match, to help you save for retirement.
• Monthly Phone/Internet Reimbursement: Stay connected with our monthly phone and internet reimbursement, ensuring you have the tools you need to excel in your role.
• Comprehensive Life and AD&D Coverage: Enjoy peace of mind with 100% premiums covered by GGH for Basic Life and Accidental Death & Dismemberment (AD&D) insurance for full-time team members. Additionally, voluntary supplemental life insurance is offered at a discounted rate.
• Short-Term Disability Coverage: Gain additional financial security with voluntary short-term disability (STD) coverage. This benefit provides a percentage of your salary during periods of illness or injury that prevent you from working for a set period of time.
• Collaborative and Supportive Community: Join our collaborative and supportive GGH Nurse Practitioner Community, with dedicated care coordinators and MD advisors, to foster professional growth and success

Don't check off every box in the requirements listed above? Please apply anyway! Studies have shown that marginalized communities - such as women, LGBTQ+ and people of color - are less likely to apply to jobs unless they meet every single qualification. GGH is dedicated to building an inclusive, diverse, equitable, and accessible workplace that fosters a sense of belonging – so if you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, we encourage you to still consider applying. You may be just the right candidate for this role or another one of our openings!