Senior Risk Adjustment Coding Quality Assurance Specialist
| Company | Homeward Health |
|---|---|
| Location | Austin, TX, USA, San Mateo, CA, USA, Chicago, IL, USA |
| Salary | $80000 – $90000 |
| Type | Full-Time |
| Degrees | |
| Experience Level | Senior |
Requirements
- 5 years of experience in risk adjustment coding and/or 3 years of outpatient CDI with a strong focus on Medicare Advantage risk adjustment
- Certified Risk Adjustment Coder (CRC) certification
- In-depth knowledge of Medicare Advantage risk adjustment methodology and coding guidelines
- Strong understanding of ICD-10-CM diagnosis coding
- Excellent communication skills
- Familiarity with risk adjustment retrospective chart review coding processes and technology
- Familiarity with electronic health record (EHR) systems
- Knowledge of healthcare compliance, regulations, and billing practices
- Analytical and problem-solving skills
Responsibilities
- Conduct in-depth second-level reviews of outpatient clinical documentation, focusing on identifying and supporting accurate, complete capture of risk-adjustable conditions for Medicare Advantage members
- Lead quality assurance (QA) audits to assess documentation integrity, identify trends in missed opportunities, and ensure coding accuracy
- Champion precise documentation that fully reflects the clinical complexity of Medicare Advantage patients
- Ensure that all active, reportable diagnoses are clearly supported with Diagnosis/Status/Plan (DSP) elements within the encounter
- Maintain deep expertise in CMS risk adjustment guidelines, Medicare Advantage policies, and ICD-10-CM coding rules
- Translate these evolving requirements into practical applications for documentation review and improvement
- Deliver timely, actionable feedback and education to providers, grounded in DSP-aligned documentation principles
- Engage in one-on-one coaching, small-group huddles, and educational content development to drive understanding of how accurate documentation impacts patient care quality and risk-adjusted performance
- Ensure coding and documentation practices strictly adhere to Medicare Advantage regulations
- Monitor for patterns that may indicate compliance concerns and proactively guide corrective strategies to reduce risk exposure
- Partner in the ongoing development and scaling of Homeward’s outpatient CDI and Coding Support functions
Preferred Qualifications
- Additional AAPC or AHIMA certification (RHIA, RHIT, CDIP, etc.)
- Experience with risk adjustment technology solutions and risk adjustment retrospective chart review vendors
- Previous experience building from the ground up on a small, fast-paced team
- Experience with Medicare Advantage RADV audits