Employer Industry: Healthcare

Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Fully remote position with flexibility in work location within Delaware, New Jersey, and Pennsylvania
- Competitive pay and comprehensive benefits package
- Engage in meaningful work that enhances the health and well-being of communities
- Supportive and collaborative work environment

What to Expect (Job Responsibilities):
- Analyze member clinical charts, diagnosis data, and CPT codes to assess coding accuracy and identify improvement opportunities
- Perform prospective chart coding reviews and recommend solutions to enhance clinical data quality for Medicare Advantage and Commercial HIX plans
- Identify and communicate trends in provider coding and documentation
- Collaborate with the Sr. Clinical Analyst to guide staff in Population Health regarding clinical risk adjustment procedures and resolve related issues
- Train providers on risk adjustment coding policies both virtually and on-location

What is Required (Qualifications):
- CPC (Certified Coding Professional) credential required
- CRC (Certified Risk Adjustment Coder) credential required, must obtain within one year of hire
- Minimum of 3+ years’ experience in risk adjustment coding activities within a Medicare/ACA or provider organization
- Strong knowledge of risk adjustment, Hierarchical Condition Category (HCC), and medical terminology
- Excellent analytical, problem-solving, and communication skills

How to Stand Out (Preferred Qualifications):
- RN license preferred but not required
- Demonstrated ability to research, analyze, and interpret CMS coding and documentation guidelines
- Experience in coding guideline and policy implementation
- Knowledge of ICD-9 / ICD-10 diagnosis and procedure codes, CPT codes, Revenue codes, and HCPCS codes
- Strong organizational and planning skills

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