Risk Adjustment Manager (Onsite in West Palm Beach, FL)

Job Description

Job Description

About the Role

Our multi-site primary care medical group is seeking an experienced MRA Coder and Educator to lead risk adjustment coding education and training across our West Palm Beach–area clinics. This role is central to ensuring accurate, complete, and compliant HCC/risk adjustment documentation and coding practices among our primary care providers and clinical staff.

The ideal candidate is both a coding subject matter expert and a skilled communicator and presenter — someone who can translate complex risk adjustment concepts into clear, actionable training that resonates with busy physicians and site-level management, while building strong, trust-based relationships across the organization.

Key Responsibilities

• Design, develop, and deliver engaging risk adjustment (HCC) coding education and training programs for primary care providers (PCPs), APPs, and clinical documentation staff across multiple sites, tailoring content to each provider's specific documentation trends and coding patterns .
• Conduct live and virtual training presentations , provider one-on-ones, and group education sessions on risk adjustment accuracy, documentation specificity, and coding compliance.
• Partner closely with physicians and site management to identify documentation gaps, coding trends, and opportunities for improvement, tailoring education to each site's needs.
• Perform prospective and retrospective chart reviews/audits to identify trends in HCC capture, documentation accuracy, coding gaps, and recapture opportunities; use findings to inform targeted education.
• Conduct HEDIS chart reviews and quality measure abstraction , identifying gaps in care and documentation deficiencies tied to key quality measures; provide feedback and education to providers on closing HEDIS gaps.
• Support integration of risk adjustment and HEDIS/quality workflows , helping providers and staff understand how accurate coding and documentation impact both RAF scores and quality measure performance.
• Interpret payor coding/risk adjustment reports (e.g., suspect lists, gap reports, RAF/HCC performance reports) and translate findings into targeted provider education and site-level action plans.
• Serve as a liaison with health plan/payor partners on coding performance and accuracy initiatives, participating in payor meetings and collaborating on strategies to improve documentation and coding outcomes.
• Review charts and validate diagnosis coding accuracy prior to claims submission , ensuring documentation supports coded conditions and flagging discrepancies for correction before claims go out.
• Track and report on provider coding performance, RAF score accuracy, HEDIS gap closure rates, and training outcomes ; provide actionable feedback to leadership.
• Stay current on CMS, HHS, RxHCC risk adjustment methodology, HCC model updates, ICD-10-CM coding guidelines, and payer-specific requirements , translating regulatory changes into practical provider guidance.
• Serve as a trusted resource and liaison between coding/compliance teams and clinical staff, fostering a culture of documentation accuracy and coding integrity.
• Develop training materials, job aids, quick-reference tools, and provider scorecards to reinforce education between formal sessions.
• Support new provider onboarding related to risk adjustment coding expectations and workflows.
• Monitor industry and regulatory changes and proactively update training content and strategy accordingly.

Required Qualifications

• Minimum 5 years of experience delivering risk adjustment (HCC) coding education and training specifically to primary care providers .
• Active coding credential required: CRC (Certified Risk Adjustment Coder) preferred; CPC, CCS, or equivalent also considered.
• Demonstrated, proven track record of improving risk coding accuracy and optimization (RAF accuracy, HCC recapture, documentation improvement metrics).
• Strong working knowledge of CMS-HCC and/or HHS-HCC, RX and ESRD HCC risk adjustment models , ICD-10-CM coding guidelines, and CMS documentation requirements.
• Hands-on experience conducting chart reviews/audits (concurrent, prospective and retrospective) for risk adjustment purposes.
• Working knowledge of HEDIS measures and quality chart abstraction , with the ability to identify and communicate care/documentation gaps to providers.
• Demonstrated experience interpreting payor coding reports (suspect lists, gap reports, RAF/HCC performance data) and using them to drive provider education.
• Experience liaising directly with payors/health plans to enhance coding performance and accuracy.
• Ability to review charts and validate diagnosis accuracy prior to claims submission , ensuring coded conditions are fully supported by documentation.
• Exceptional presentation and public speaking skills , with demonstrated ability to train and engage physicians and clinical staff in both individual and group settings.
• Excellent interpersonal and relationship-building skills , with a track record of effective collaboration with physicians, practice administrators, and site leadership.
• Strong analytical skills with experience interpreting coding/audit data to drive education strategy.
• Highly organized, self-directed, and comfortable managing training schedules across multiple clinic locations .
• Must be local to work on-site in the Palm Beach County area, with willingness to travel between sites as needed.

Preferred Qualifications

• Experience in a multi-site primary care or value-based care organization .
• Familiarity with EHR-based documentation workflows and coding/audit software tools.
• Experience developing formal curricula or structured provider education programs.
• Background supporting Medicare Advantage risk adjustment programs specifically.
• Experience with HEDIS reporting cycles, NCQA requirements, or quality/STARS programs in a value-based care setting.