Risk Adjustment Coding Specialist
About The Position
The Risk Adjustment Coding Specialist will play a pivotal role in supporting accurate and complete diagnosis documentation as part of Gather Health’s commitment to value-based care under Medicare Advantage and ACO REACH contracts. Embedded within a collaborative, interdisciplinary team—including primary care providers, clinical support staff, and care coordination specialists—this role ensures that coding practices align with clinical realities, driving both quality outcomes and appropriate reimbursement. With deep expertise in the CMS-HCC Risk Adjustment Payment Model (V28), Hierarchical Condition Category (HCC) and CPT coding, the Specialist will serve as a trusted partner to providers, offering 1:1 feedback, leading group education sessions, and identifying opportunities for documentation improvement. Through both remote and in-person collaboration, this role strengthens the connection between frontline care delivery and compliant, effective coding practices.
Requirements
- Two (2) + years previous experience as a certified professional coder
- One year of risk adjustment experience
- Certified Professional Coder through the American Academy of Professional Coders (AAPC) or Certified Coding Specialist through the American Health Information Management Academy (AHIMA)
- Proficient computer skills, Microsoft Office Suite (Word, PowerPoint, Outlook, and Excel)
- Must live in the surrounding Boston area and willing to visit our four (4) centers regularly
Nice To Haves
- Certified Risk Adjustment Coding certificate (CRC) preferred
- 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
Responsibilities
- 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)
- Ensuring that all documented risk adjusted conditions or HCCs are compliantly supported via the MEAT criteria
- 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.
Benefits
- Comprehensive medical, dental, and vision with day-one eligibility
- Company-paid Life, Short-Term, and Long-Term Disability insurance
- 401(k) with company match and immediate vesting
- Generous PTO that increases with tenure and 11 paid company holidays
- Employee Assistance Program (EAP) and supplemental benefit options
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
Number of Employees
1-10 employees
