Risk Adjustment Coding Specialist at Gather Health

Boston, Massachusetts, United States -

Full Time

Start Date

Immediate

Expiry Date

14 May, 26

Salary

85000.0

Posted On

13 Feb, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Risk Adjustment Coding, HCC Coding, CPT Coding, Medical Coding Guidelines, Chart Review, Documentation Accuracy, Interpersonal Skills, Communication, Time Management, Prioritization, Multitasking, Self-Motivation, Microsoft Office Suite, Value-Based Care, Medicare Advantage, ACO REACH

Industry

Health;Wellness & Fitness

Description

Description Who is Gather Health? We are a new and growing healthcare organization with a unique and innovative approach to healthcare. Our mission is to improve lives and communities through socially supported primary care for older adults. Our innovative business model allows our clinicians to treat the whole patient - not just their clinical needs. We do this by having a dedicated care team that supports our clinicians by addressing our patients’ social determinants of health and providing the highest quality of service possible. Our ultimate vision is creating generational health and equity for communities across the country, one patient at a time. Position Overview Gather Health is seeking a Risk Adjustment Coding Specialist to join our growing team. This role is critical to ensuring the accuracy and completeness of diagnosis documentation and coding to support value-based care under Medicare Advantage and ACO REACH contracts. The ideal candidate has a deep understanding of HCC and CPT coding, is detail-oriented, and has strong interpersonal skills to provide feedback and education to PCPs. This role is primarily remote but may require periodic onsite meetings for one-on-one or group provider educational sessions, and team meetings as needed. Duties Making sure that codes are assigned correctly and sequenced appropriately as per government and insurance regulations Complying with medical coding guidelines and policies Reviewing patients’ charts and documents for verification and accuracy (retrospective, prospective and Concurrent Chart Review) Maintaining productivity and quality standards as set by the company Communicating professionally with co-workers regarding clinical and reimbursement issues Reporting missing or incomplete documentation while working with the providers to fix documentation errors. Following up and clarifying any information that is not clear to PCPs. Preferred Experience & Qualifications Two (2)+ years previous experience as a certified professional coder Certified Professional Coder through the American Academy of Professional Coders (AAPC) or Certified Coding Specialist through the American Health Information Management Academy (AHIMA) High school diploma or equivalent; AS degree in accounting, health care administration, finance, business, or related field preferred Able to multitask, prioritize, and manage time efficiently Self-motivated and self-directed; able to work without supervision Excellent verbal, written, and interpersonal communication skills Proficient computer skills, Microsoft Office Suite (Word, PowerPoint, Outlook, and Excel). Gather Health delivers Social Primary Care to older adults. Through our unique and differentiated care model and proprietary technology, Gather Health’s solution drives substantial care outcomes by addressing the whole person needs of our target demographic: older, dual eligible adults, the fastest growing government segment. To address the needs of these clinically and socially complex patients, Gather Health’s Social Primary Care solution is comprehensive and wholistic in nature, encompassing care and community within the four walls of Gather Health Centers and in the homes of its patients. Gather’s model achieves superior care by individualizing care and is reinforced by a three-prong approach: a unique care model quarterbacked by PCPs and supported by multi-disciplinary care teams, tailored Social Care Plans that are led by Gather Guides and facilitated by deeply rooted community partners, and a proprietary “Tech Enabled Home Model.” Founded in 2022 and born out of the Healthcare Foundry Portfolio, Gather Health is addressing a $1 trillion market in primary care for older adults. Today, Gather Health operates in Massachusetts and is working with a multitude of payer partners on aligning value-based care economics to deliver integrated care. Gather’s leadership team has a track record of building and scaling innovative primary care platforms focused on vulnerable populations, including VillageMD and Commonwealth Care Alliance. Gather has raised $30M backed by Maverick Ventures, Khosla, and HC9 Ventures. We are committed to supporting every aspect of your life by offering a total rewards package designed to support your health, financial security, and work-life balance: Health: Comprehensive medical, dental, and vision with day-one eligibility Protection: Company-paid Life, Short-Term, and Long-Term Disability insurance Retirement: 401(k) with company match and immediate vesting Time Off: Generous PTO that increases with tenure and 11 paid company holidays Wellness: Employee Assistance Program (EAP) and supplemental benefit options Gather Health is an Equal Opportunity Employer. All employment decisions are made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status, or any other basis as protected by federal, state, or local law.

Responsibilities

The specialist is responsible for ensuring the accuracy and completeness of diagnosis documentation and coding to support value-based care contracts by correctly assigning and sequencing codes per regulations. Duties include reviewing patient charts, maintaining quality standards, communicating with co-workers, and reporting/fixing documentation errors with providers.