Risk Adjustment Coder

Job Description

Job Description

*Hybrid Role, must be located in State of Colorado*

Join Carina Health Network and help us make Colorado communities healthier!

Are you passionate about population health and interested in improving patient experience and outcomes? If so, we support several community health organizations (CHO), and this company is for you!

At Carina Health Network, we are transforming community health by delivering proactive, data-informed, and whole-person care that drives measurable impact. Our work helps people stay healthier longer, by supporting community health organizations who have patients with chronic conditions like diabetes and high blood pressure, ensuring regular check-ups for older adults, and identifying mental health needs early. We help community health organizations prevent costly ER visits by connecting people with the right care at the right time. Through our value-based care programs, we empower frontline care teams to improve outcomes while earning fair, sustainable reimbursement. By saving money and reinvesting in community services, we strengthen the systems that care for the most vulnerable, making a real difference in the lives of patients and providers alike. Join us in reimagining the future of health care, where your work truly matters.

What You’ll Do

The Value Based Coding Advisor will interact with operational and clinical leadership to assist in the identification of Risk Adjustment/HCC coding opportunities, and will provide targeted education to CHC providers, billers, coders, and support staff to support value-based contract initiatives.

Risk Adjustment/HCC Coding Support and Education

• Educates providers and staff on coding regulations and changes as they pertain to risk adjustment and quality reporting to ensure compliance with federal and state regulations.
• Assist the department, direct supervisor and Carina in the development of education tools related to risk adjustment/HCC coding and gap closure.
• Supports the creation of education that will train CHC providers, billers, coders, and support staff, as well as Carina staff, for risk adjustment/HCC coding opportunities.
• Maintains a database with the results of all medical chart reviews performed, with ability to report on progress and statistics on coding initiatives.

Pre-Visit Planning (PVP)

• Performs weekly Pre-Visit Planning reviews for assigned CHC’s and will query providers or other identified team member to further
• Value-based contract initiatives including coding recommendations based on internal and external medical records, review of payer portals and suspected conditions, and review of care gap and clinical documentation.

CHC Support

• Holds monthly meetings with identified coding champions, provide education and training to CHC providers, billers, coders, and support staff in proper coding guidelines; and documentation education based on PVP observations and monthly topics.
• Provides monthly chart reviews of randomly selected patients and providers participating in Pre-Visit Planning (PVP) program to give feedback on missed opportunities and errors.

Gap Closure Success

• Reviews patient charts to identify areas for quality gap closures and provide compliant documentation to appropriate payers resulting in gap closures for assigned CHC’s.
• Ensures that providers understand CPT II coding for the purposes of quality gap closure and reporting.

What We’re Looking For

• High School diploma or equivalent.
• Minimum 2 years coding experience
• The American Academy of Professional Coders (AAPC) Certified Risk Adjustment Coder (CRC) or AHIMA certification is required; Certified Professional Coder (CPC) Certification will be considered with Risk Adjustment/HCC Coding experience and willingness to obtain CRC within 1 year of employment
• Risk Adjustment experience required.
• FQHC billing experience is highly preferred
• Experience with clinic billing and coding required
• Knowledge of several EHR systems preferred (ECW, Athena, Greenway Intergy, Epic).
• Clinical background preferred
• Strong knowledge of CMS coding and quality guidelines.
• Strong knowledge of PowerPoint, excel and Microsoft word with the ability to manipulate basic information and data required for preparing reports and delivering training.
• Exceptional interpersonal, public speaking, and presentation skills to deliver training and education is preferred.
• Ability to facilitate group discussions that challenge participants and promote discussion of new approaches and solutions based on data and value-based care initiatives.
• Ability to travel to and within the state of Colorado- 25% travel within the state of Colorado with an unrestricted driver’s license and an insured vehicle.

Working Environment

• Work from home with 25% travel responsibilities within the state of Colorado
• Prolonged periods of sitting at a desk and working on a computer

Why You’ll Love Working Here

• Insured group health, dental, & vison plans (Employer covers 100% cost for dental and vision)
• Medical and dependent care flexible spending account options
• *$900 Employer Contributions towards your choice of a Health Reimbursement Employer (HRA) or Health Savings Account (HSA)
• 401k retirement plan with up to a 4% employer contribution match
• 100% Employer-Paid Life, AD&D, Short-Term and Long-term disability plans paid for employees
• Free 24/7 access to confidential resources through an Employee Assistance Program (EAP)
• Voluntary benefit plans to complement health care coverage including accident insurance, critical illness, and hospital indemnity coverage
• 17 days of paid vacation within 1 year of service
• 12 paid sick days accrued by 1 year of service
• 14 paid holidays (which includes 2 floating holidays)
• 1 Paid Volunteer Day
• Employer-paid programs/courses for staff’s growth and development
• Cell phone and internet reimbursement
• Competitive salary and full benefits
• Annual, all expenses paid Staff Retreat
• Flexible work (remote or hybrid)
• Supportive, mission-driven team
• Opportunities to learn and grow

Carina Health Network is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

This job will be posted until 11/30/26 or until filled.