Medicare Risk Adjustment Specialist I at On Belay Health Solutions

, , United States -

Full Time

Start Date

Immediate

Expiry Date

22 Sep, 26

Salary

28.0

Posted On

24 Jun, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Medicare Risk Adjustment, HCC Coding, ICD-10-CM, Medical Chart Review, Clinical Documentation, Microsoft Excel, EMR Navigation, Quality Assurance, Time Management, Interpersonal Communication

Industry

Hospitals and Health Care

Description

About the role We are seeking a detail-oriented Medicare Risk Adjustment Coding Specialist to support our innovative AI-driven chart review and risk adjustment programs. This role differs from a traditional retrospective chart review position. Rather than conducting full manual chart reviews, the specialist will work alongside advanced AI technology to validate, refine, and support coding opportunities identified through automated chart analysis. The ideal candidate will possess strong knowledge of Medicare Advantage risk adjustment methodologies, HCC coding, and clinical documentation requirements, while demonstrating the ability to evaluate AI-generated coding recommendations and ensure accuracy, compliance, and coding integrity. This is a Full-Time role with expectation for 40 hours per week. We look forward to meeting interested applicants and mutually assessing fit in joining On Belay on our important mission to transform healthcare! What you'll do Review and validate AI-identified risk adjustment coding opportunities within medical records. Assess clinical documentation to determine the appropriateness of proposed diagnoses and HCC submissions. Support the quality assurance process for AI-assisted chart reviews by identifying coding discrepancies, false positives, and missed opportunities. Develop feedback loop with On Belay’s Head of Risk Adjustment Coding and physician offices On Belay supports, including but not limited to: Identification of quality improvement opportunities in individual physician coding Any other related duties assigned at manager’s discretion Qualifications High school diploma or GED required. Associates degree preferred. Active coding certificate required. AAPC or AHIMA coding certification preferred. Required: CCS-P (Certified Coding Specialist- Physicianbased) or CPC (Certified Professional Coder) Preferred: CRC (Certified Risk Adjustment Coder) Experience in a primary care setting highly preferred. Knowledge of medical terminology and medical chart review required. Two (2) or more years’ experience of hierarchical condition categories (HCC) Knowledge of ICD-10-CM Official Guidelines for Coding and Reporting Knowledge of AHA Coding Clinic and authoritative coding resources Knowledge of Microsoft Office suite, primarily Excel (specifically Pivot Tables, sort and filter functions) Strong time management skills required Ability to navigate within various EMRs (Electronic Medical Records), Cerner Preferred Strong interpersonal, communication (verbal, non-verbal and listening) skills Ability to remain productive under time constraints and meet deadlines critical to the business Benefits Innovative, revolutionary environment Great culture with a strong sense of mission and community Eleven (11) Paid Holidays Lavish PTO accrual Advancement opportunities & professional skills training Strong referral bonus program And more! Compensation We offer a competitive base salary ranging from $25 - $28 per hour. Come join us on the journey to better and more affordable healthcare! We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.

Responsibilities

Validate and refine AI-identified risk adjustment coding opportunities within medical records to ensure accuracy and compliance. Support quality assurance by identifying coding discrepancies and providing feedback to physician offices.