Risk Adjustment & Quality Coding Specialist

Job Description

Job Description

Community Clinic is a trusted regional healthcare system dedicated to delivering exceptional, whole-person care in a compassionate, professional, and welcoming environment. As we continue to grow across the region, we remain grounded in one belief: people matter. That includes our patients—and our team. Every employee plays a vital role in living out our promise: We care. You belong.

Job Summary

We are seeking a Risk Adjustment & Quality Coder to join our Springdale Admin team! The Risk Adjustment & Quality Coding Specialist is a highly specialized, standalone role within the Coding team. This individual owns the organization's risk adjustment coding process and serves as the primary bridge to the Clinical Quality Care Team. The specialist performs comprehensive CMS-HCC risk adjustment reviews, collaborates directly with the Quality Team to align on targeted metrics, and acts as the subject matter expert who educates and audits the general coding staff to ensure quality data is captured accurately across the department. The schedule for this position is remote/hybrid role, full-time, with a schedule Monday - Friday 8:00AM - 5:00 PM

Responsibilities

Risk Adjustment and Coding Ownership (40%)

• Serve as the dedicated coder responsible for reviewing medical records to capture, validate, and assign accurate ICD-10-CM codes for chronic conditions under the CMS-HCC model.
• Ensure full compliance with official coding guidelines and MEAT documentation criteria, managing the provider query process when clinical documentation lacks required specificity.
• Maintain maximum coding accuracy while balancing the unique dual-production and administrative needs of this program.

Quality Metrics Support & Strategy (25%)

• Meet regularly with the Quality Care Team to review organizational performance dashboards and determine which specific quality measures (HEDIS/Stars) will be actively tracked.
• Translate clinical quality initiatives into concrete coding practices, ensuring the department is set up to capture the precise data points required to close clinical care gaps.

Internal Education & Coding Support (20%) 

• Educate the general coding staff on how to properly recognize and capture targeted quality codes during their standard workflow.
• Develop training materials, tools, and documentation workflows to simplify quality capture for the rest of the coding team.
• Provide ongoing regulatory updates and guidance regarding changes to risk adjustment models and quality specifications.

Quality Assurance & Internal Auditing (15%)

• Educate the general coding staff on how to properly recognize and capture targeted quality codes during their standard workflow.
• Develop training materials, tools, and documentation workflows to simplify quality capture for the rest of the coding team.
• Provide ongoing regulatory updates and guidance regarding changes to risk adjustment models and quality specifications.

Community Clinic Essential Competencies

• Service: Treats every patient and coworker with empathy, respect, and a genuine desire to help.
• Ownership: Takes responsibility for their actions, follows through on commitments, and upholds high standards even when no one is watching.
• Adaptability: Remains flexible, open to change, and willing to learn in order to meet the evolving needs of our patients, teams, and organization.
• Collaboration: Works together with openness and respect, shares information freely, and supports co-workers to provide seamless, high-quality care.
• Collaboration: Works together with openness and respect, shares information freely, and supports co-workers to provide seamless, high-quality care.
• Problem Solving: Approaches challenges with curiosity, finds practical solutions, and takes initiative to improve processes and patient experiences.