HCC - Risk Adjustment Coder (Central Valley and Northern California - Hybrid)

HCC

• Risk Adjustment Coder (Central Valley and Northern California
• Hybrid) Amada Health Fresno, CA Job Details Full-time $56,160
• $72,800 a year 20 hours ago Benefits Health savings account Health insurance Dental insurance 401(k) Paid time off Parental leave Employee assistance program Vision insurance Referral program Qualifications Teamwork Medicare Medical Coding Certification Certified Professional Coder Retrospective medical coding audits Health insurance knowledge Medicare regulations Centers for Medicare & Medicaid Services (CMS) billing regulations Certified Risk Coder (CRC) Clinical documentation standards Documentation review Medical record review for billing accuracy Time management Full Job Description About Amada Health Amada Health is an innovative and fast-growing Independent Physician Network dedicated to advancing high-quality, value-based care throughout Central Valley.

With a strong and expanding presence across Central Valley, Northern California and the Bay Area, Amada Health continues to build meaningful partnerships with providers committed to improving patient outcomes and strengthening community health. What makes Amada Health truly special is our people. Our organization promotes a culture of collaboration and support, where teams work together to advance quality initiatives, strengthen risk adjustment accuracy, and support our provider partners in delivering outstanding care to the communities we serve. Job Overview Amada Health is seeking a motivated Coder with Medicare Advantage Risk Adjustment (HCC) coding experience to join our growing Quality & Risk Adjustment team. This role works closely with providers to validate documentation accuracy with a hyper-focus on accurate

ICD-10-CM

diagnosis code assignment, HCC capture, and provider education to support compliant documentation and optimal risk adjustment reporting. Our team fosters a collaborative and supportive environment that encourages professional growth. Coders have the opportunity to expand their expertise across risk adjustment and quality initiatives while participating in ongoing education, training, and professional development. Candidates with Medicare Advantage HCC coding and RAF experience are strongly encouraged to apply. Responsibilities Review medical records to validate

ICD-10-CM

diagnosis coding and compliant HCC capture for our Medicare Advantage enrollees, to support optimal RAF Score accuracy. Ensure compliance with CMS and OIG Risk Adjustment Guidelines, ICD-10-CM Official Coding Guidelines, and AHA Coding Clinic guidance. Develop and maintain effective working relationships with provider groups by providing constructive feedback related to chart review findings and missed opportunities. Complete chart audits including review of hospital professional services, timely to meet all CMS Sweep deadlines. Conduct retrospective and prospective chart reviews and coding audits to support RADV readiness, HCC validation, and risk adjustment compliance. Conduct timely pre-visit chart reviews for assigned provider groups to identify and present open care gaps and outstanding chronic conditions. Conduct post-visit reviews to ensure documentation supports pre-visit suggestions and aligns with claim submissions. Support and participation with HEDIS | 5 Star audits and initiatives. Experience Required Certified RAF Coder (CRC required within 6 months) 1

• 2 years' experience with HCC coding, guidelines and MEAT criteria Strong knowledge of

ICD-10-CM

coding guidelines Strong understanding of Medicare Advantage Risk Adjustment model Prospective and Retrospective chart review experience Familiarity with Annual Wellness Visit (AWV) documentation requirements Maintain Coding Certification Maintain coding accuracy (≥95%) Maintain Quality Department productivity standards Preferred Certified Professional Coder (CPC) Experience working with IPA, Medical Group, or Health Plan Risk Adjustment programs Knowledge of RADV audit standards Experience using electronic health records (EHR) and risk adjustment analytics tools Experience with HEDIS | 5 Star gap closure HHS-HCC Coding experience Skills Moderate/Proficient in Excel Strong attention to detail Excellent communication Strong organization and time management Ability to manage multiple priorities and meet deadlines Ability to collaborate with colleagues, providers and clinical staff Compensation

• Hourly, compensation will be considered based on Certification type, Medicare Advantage Risk Adjustment knowledge, and HCC Coding experience. Location
• Hybrid (Central Valley & Northern CA) NOT fully-remote.

Pay:

$56,160.00

• $72,800.

00 per year

Benefits:

401(k) Dental insurance Employee assistance program Health insurance Health savings account Paid time off Parental leave Referral program Vision insurance

Experience:

HCC Coding:

1 year (Preferred)

Medical Coding:

1 year (Required)

License/Certification:

Medical Coding Certification (Required) Shift availability: Day Shift (Required)

Work Location:

Hybrid remote in Fresno, CA 93720