Risk Adjustment Coding Specialist

Description Who is Gather Health? We are a new and growing healthcare organization with a unique and innovative approach to healthcare. Our mission is to improve lives and communities through socially supported primary care for older adults. Our innovative business model allows our clinicians to treat the whole patient - not just their clinical needs. We do this by having a dedicated care team that supports our clinicians by addressing our patients’ social determinants of health and providing the highest quality of service possible. Our ultimate vision is creating generational health and equity for communities across the country, one patient at a time. The Risk Adjustment Coding Specialist The Risk Adjustment Coding Specialist will play a pivotal role in supporting accurate and complete diagnosis documentation as part of Gather Health’s commitment to value-based care under Medicare Advantage and ACO REACH contracts. Embedded within a collaborative, interdisciplinary team—including primary care providers, clinical support staff, and care coordination specialists—this role ensures that coding practices align with clinical realities, driving both quality outcomes and appropriate reimbursement. Duties & Responsibilities Making sure that codes are assigned correctly and sequenced appropriately as per government and insurance regulations Complying with medical coding guidelines and policies Reviewing patients’ charts and documents for verification and accuracy (retrospective, prospective and Concurrent Chart Review) Ensuring that all documented risk adjusted conditions or HCCs are compliantly supported via the MEAT criteria Maintaining productivity and quality standards as set by the company Communicating professionally with co-workers regarding clinical and reimbursement issues Reporting missing or incomplete documentation while working with the providers to fix documentation errors Following up and clarifying any information that is not clear to PCPs Minimum Requirements Two (2)+ years previous experience as a certified professional coder One year of risk adjustment experience Certified Risk Adjustment Coding certificate (CRC) preferred Certified Professional Coder through the American Academy of Professional Coders (AAPC) or Certified Coding Specialist through the American Health Information Management Academy (AHIMA) Proficient computer skills, Microsoft Office Suite (Word, PowerPoint, Outlook, and Excel) Must live in the surrounding Boston area and be willing to visit our four centers regularly Preferred Skills AS degree in accounting, health care administration, finance, business, or related field preferred Able to multitask, prioritize, and manage time efficiently Self-motivated and self-directed; able to work without supervision Excellent verbal, written, and interpersonal communication skills About the Role Gather Health delivers Social Primary Care to older adults. Through our unique and differentiated care model and proprietary technology, Gather Health’s solution drives substantial care outcomes by addressing the whole person needs of our target demographic: older, dual eligible adults, the fastest growing government segment. To address the needs of these clinically and socially complex patients, Gather Health’s Social Primary Care solution is comprehensive and wholistic in nature, encompassing care and community within the four walls of Gather Health Centers and in the homes of its patients. Gather’s model achieves superior care by individualizing care and is reinforced by a three-prong approach: a unique care model quarterbacked by PCPs and supported by multi-disciplinary care teams, tailored Social Care Plans that are led by Gather Guides and facilitated by deeply rooted community partners, and a proprietary “Tech Enabled Home Model.” Benefits Health: Comprehensive medical, dental, and vision with day-one eligibility Protection: Company-paid Life, Short-Term, and Long-Term Disability insurance Retirement: 401(k) with company match and immediate vesting Time Off: Generous PTO that increases with tenure and 11 paid company holidays Wellness: Employee Assistance Program (EAP) and supplemental benefit options Equal Opportunity Employer Gather Health is an Equal Opportunity Employer. All employment decisions are made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state or local law. #J-18808-Ljbffr