Risk Adjustment Coder I - Sacramento (Central/South) Hybrid 25-234

We’re delighted you’re considering joining us!

At Hill Physicians Medical Group, we’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

Join Our Team!

Hill Physicians has much to offer prospective employees.  We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you’re making a great choice for your professional career and your personal satisfaction.

DE&I Statement:

At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Job Description:

The Risk Adjustment Coder I provides support and coding expertise to all programs supporting risk adjustment and data validation efforts for Medicare and Commercial lines of business, as well as other ad hoc and long-term projects assigned by the Manager, Government Programs. These projects directly impact revenue and prepare the organization for health plan, CMS, and HHS audits. The Risk Adjustment Coder I will develop analytics, create education materials, conduct in-person and virtual provider trainings, and serve as the subject matter expert (SME) for all HCC coding initiatives. This position requires significant interaction with physician leadership, the provider network, and various internal departments (e.g., Regional Services, Clinical Services, and Case Management). Building and maintaining strong relationships across the organization is critical to success.

ESSENTIAL RESPONSIBILITIES (% of time spent; total should equal 100%):

• Perform risk adjustment data validation to ensure accurate and compliant code submission.
• Develop and present HCC education materials for practices, panel meetings, new physician orientation, provider specialty management teams (SMT), and internal departments.
• Facilitate “Train the Trainer” sessions on risk adjustment and coding interventions for internal teams to educate the provider network.
• Conduct in-person and virtual trainings for providers and staff, adapting content to meet the needs of hybrid work environments.
• Coordinate Annual Wellness Visit (AWV) and quality resources; monitor and evaluate performance of related interventions.
• Responsible for presenting Government Programs updates at various forums (e.g., Practice Manager Meetings, SMT, HillMetrics Support Forums).
• Assists management with onboarding and training of new hires and represent the team at health plan partner meetings.
• Identify opportunities to improve documentation and coding accuracy; provide analysis and initiate HCC coding interventions with practices to enhance performance.
• Analyze internal systems and processes to identify and resolve issues that hinder accurate encounter data capture.
• Conduct prospective reviews of current and suspect conditions to optimize documentation and coding.
• Provide real-time education and feedback during patient visits to ensure accurate health status capture.
• Conduct billing education/review to ensure all codes are captured on claim.
• Monitor and track practice performance in the areas of HCC recapture, suspect recapture, and RAF score improvements.

SKILLS AND EXPERIENCE REQUIRED:

• Proficient in Microsoft Excel, Word, and PowerPoint.
• Strong written and verbal communication skills.
• Ability to effectively operate in hybrid (in-person and virtual) work environments.
• Familiarity with EMR systems (Epic experienced preferred).
• Strong organizational skills and attention to detail.
• Ability to work independently and effectively problem-solve.
• Proven ability to clearly communicate verbally and in writing.

REQUIRED EXPERIENCE:

• Certified professional medical coding credentials
• 1+ year of experience in HCC coding and auditing (medical chart review).
• Experience working in a healthcare or physician office setting preferred.
• Valid driver’s license and proof of auto insurance.

REQUIRED EDUCATION:

• Bachelor’s degree preferred plus experience in a healthcare setting.
• AAPC/AHIMA Certification.

Additional Comments

• Travel to physician practices and regional offices will be required on a weekly basis. With few exceptions, travel will be limited to the San Francisco Bay Area, Sacramento, and San Joaquin and will occur within normal business hours.

SUPERVISORY DUTIES:

No supervisory duties required.

TRAVEL:

Travel to regional offices may be required on a weekly basis.  With few exceptions, travel will be limited to the San Francisco Bay Area, Sacramento, and San Joaquin and will occur within normal business hours.

Salary range: $71,000.00 - $86,000.00

This is a hybrid position

Hill Physicians is an Equal Opportunity Employer