TGH Senior Center Powered by Greenbrook Medical · 15 hours ago
Medicare Risk Adjustment Specialist (Coder)
United States
Full-time
Remote
Mid Level
$33/hr - $36/hr
3+ years expGreenbrook Medical is a healthcare organization focused on providing high-touch, relationship-based primary care to seniors. They are seeking a Medicare Risk Adjustment Specialist to ensure accurate coding and documentation for Medicare Advantage beneficiaries while maintaining high standards of quality and performance.
Hospital & Health Care
Responsibilities
Utilizes ICD-10, CPT and HCPCS codes for reporting diagnoses and procedures
Maintains performance and quality by conducting ongoing audits of physicians’ medical records to ensure that submitted ICD-10-CM codes are fully supported by the clinical documentation
Assigns all potential HEDIS-allowable codes for appropriate services to be captured
Ensures progress notes are coded accurately and to the highest level of specificity following established coding guidelines. Ability to abstract valid codes from hospital claims data, radiology reports, and specialist provider notes
Reviews and completes system generated reports to correct or complete missing data as requested
Analyzes MRA reports to identify and confirm unreported and/or unresolved medical conditions of members based on supportive medical documentation
Effectively communicates the audit process and results to appropriate management, and assist senior level staff in providing recommendations for process improvement so that productivity and quality goals can be met, and operational efficiency can be achieved
Queries the physician for clarification and to obtain accurate and complete documentation as needed
Enhances and maintains coding knowledge and skills
Provides feedback and problem solves coding issues with the team
Maintains patient confidentiality at all times, according to legal requirements and privacy laws. Follows established policies and procedures
Educates providers on HCC Coding and clinical documentation requirements related to risk adjustment
Supports ongoing review and query process to ensure that any amendment occurs in a timely and compliant manner
Effectively manages special projects and other tasks as assigned
Actively participates in team and departmental meetings to stay aligned on goals, share insights, and support continuous improvement
Collaborates effectively with colleagues across teams and departments to achieve shared objectives and foster a positive, team-oriented work environment
Deliver consistent chart review accuracy of 95% or higher, ensuring exceptional attention to clinical detail and coding precision
Complete 40–50 medical charts daily with efficiency and accuracy, contributing to timely and high-quality risk adjustment outcomes
Qualification
Required
Certified Professional Coder (CPC) required
At least 3 years of experience with risk adjustment or HCC coding
Minimum three-years of coding experience using ICD-10
Minimum 1 year of experience with HEDIS/Stars
Minimum High School degree or equivalent
Advanced knowledge of medical codes, terminology, abbreviations, anatomy & physiology, major disease, pharmacology and metric system
Intermediate level of proficiency in MS Office - Excel, PowerPoint, and Word
Strong organizational skills in multiple settings, as well as the ability to exercise judgment and initiative
Ability to defend coding decisions to both internal and external audits
Ability to work in a continuously changing environment
You embody our core values of Heart, Excellence, Accountability, Resilience, and Teamwork
Preferred
Certified Risk Adjustment Coder (CRC) certification strongly preferred
College or Associate degree preferred
Benefits
Paid time off
Health, dental and vision benefits
401K with a company match
Company
TGH Senior Center Powered by Greenbrook Medical
Welcome to the TGH Senior Center - A new experience designed exclusively for patients 65 and older.
2-10 employees
Funding
Current Stage
Early StageCompany data provided by crunchbase