Clinical Risk Adj Spec LPN - St. Luke's Health Partners

Description & Requirements

At St. Luke's Health Plan , we're transforming the healthcare experience by bringing providers and insurance together on the same team. As Idaho's provider-sponsored health plan, our mission is to connect people with affordable, high-quality, and hassle-free healthcare. Join us and be part of a team committed to improving outcomes, strengthening provider partnerships, and advancing value-based care.

We are seeking a Clinical Risk Adjustment Specialist (LPN) to support provider education, documentation integrity, and coding accuracy across our network. This role is ideal for an experienced LPN who enjoys working collaboratively with providers and using their clinical expertise to improve quality outcomes and compliance initiatives.

Remote opportunity for candidates located in Idaho or Oregon.
Schedule

• Monday-Friday
• 7:00 a.m.-3:30 p.m.
• No weekends

What You Can Expect

• Fully remote work environment
• Collaborative and mission-driven team
• Opportunity to partner directly with providers and care teams
• Focus on quality improvement, documentation integrity, and value-based care
• Meaningful work that impacts patient outcomes and provider performance

Responsibilities

Under general supervision, the Clinical Risk Adjustment Specialist (LPN) will:

• Support network providers and care teams with risk adjustment, billing, and coding accuracy
• Partner with health plans and internal stakeholders to support billing, coding, and documentation audits
• Provide consultative support to improve clinical documentation and coding practices
• Deliver provider education, coaching, and feedback related to coding and risk adjustment methodologies
• Review medical records to ensure accurate capture of patient complexity, severity of illness, and burden of disease
• Collaborate directly with providers to improve compliance, quality metrics, and performance outcomes
• Serve as a subject matter expert for risk adjustment, documentation integrity, and quality initiatives

Qualifications
Required

• Current Licensed Practical Nurse (LPN) license
• Minimum of 2 years of relevant experience
• Strong understanding of clinical documentation practices
• Experience collaborating with providers or interdisciplinary clinical teams
• Knowledge of medical billing, coding, and/or risk adjustment principles
• Coding certification required or must be obtained within six (6) months of hire

Preferred

• Coding or quality certification such as CPC, CCS, CRC, AAPC, or ACDIS
• Experience supporting audits, quality programs, or value-based care initiatives
• Previous experience working with health plans or provider networks

What's In It For You

At St. Luke's, caring for people in the communities we serve is our mission - and this includes our own SLHS team. We offer a robust benefits package to support our teams both professionally and personally. In addition to a competitive salary and retirement plans, we ensure our team feels supported in their benefits beyond the typical medical, dental, and vision offerings. We care about you and have fantastic financial and physical wellness options, such as: on-site massages, on-site counseling via our Employee Assistance Program, access to the Personify Health Wellness tool, as well as other formal training and career development offerings to ensure you are meeting your career goals.


St. Luke's is an equal opportunity employer and does not discriminate against any person on the basis of race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.


*Please note: this posting is not reflective of all job duties and responsibilities and is intended to provide an overview to job seekers.