编码及风险调整专家 - 临床运营
Coding & Risk Adjustment Specialist – Clinical Operations
编码和风险调整专家 临床运营公司：可用医疗地点：远程 （美国）工作类型：兼职，独立承包商 (1099) 小时：每周约520小时，灵活的补偿：与经验和参与范围相匹配 关于可用医药可用医院可用医护是一名护士创立的快速增长的医疗保健组织，致力于提高医疗保养年龄人士获得高质量的护理。通过创新的技术支持的虚拟和移动护理模式，我们支持复杂的医学，行为健康和社会需求患者。我们的团队热衷于改善患者成果，赋予临床医生权力和为贫困老年人提供可扩展护理解决方案。关于角色利用健康正在寻找经验丰富的编码与风险调整专家来支持我们不断增长的临床项目，在灵活兼职咨询能力下。在这个角色中，你将担任 Medicare Advantage 风险调节，HCC 编码和临床文档完整性方面的专家。你将与临床和运营领导层密切合作，加强编码准确性，优化文档实践，进行审计，并开发可扩展的工作流来支持合规性和程序性能。理想的候选人带来了广泛的医疗保险风险调整专业知识，对 CMS 编码要求有强烈的了解，以及翻译复杂的编码指南为临床团队的实际解决方案的经验。这是一个非常好的机会，对于一名有经验的编码专业人士来说，他喜欢独立工作，咨询卫生保健领袖，并贡献关键责任。· 作为编码和风险调整专家，提供有关 ICD-10-CM 编码，HCC 捕获和医疗保健优势文件要求的指导。·进行编码审计和临床文档审查以评估准确性，完整性，合规性和改进机会。· 审核现有编码人员并为加强编码质量和一致性提供可行的反。· 与护士从业者，医生，RN 护理管理人员以及运营领导人合作，改善在临床计划中编码实践。· 制定和实施与 CMS 要求一致的编码工作流程，政策，标准运营程序 (SOP) 和文档指导方针。·设计并提供编码教育，供应商培训。
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Coding & Risk Adjustment Specialist – Clinical Operations
Company: Avail Health
Location: Remote (U.S.)
Employment Type: Part-Time, Independent Contractor (1099)
Hours: Approximately 5–20 hours per week, flexible
Compensation: Commensurate with experience and scope of engagement
About Avail Health
Avail Health is a Nurse Practitioner-founded, rapidly growing healthcare organization dedicated to improving access to high-quality care for Medicare-age individuals. Through innovative, technology-enabled virtual and mobile care models, we support patients with complex medical, behavioral health, and social needs.
Our team is passionate about improving patient outcomes, empowering clinicians, and building scalable care delivery solutions for underserved senior populations.
About the Role
Avail Health is seeking an experienced Coding & Risk Adjustment Specialist to support our growing clinical programs in a flexible, part-time consulting capacity.
In this role, you will serve as a subject-matter expert in Medicare Advantage risk adjustment, HCC coding, and clinical documentation integrity. You will collaborate closely with clinical and operational leadership to strengthen coding accuracy, optimize documentation practices, conduct audits, and develop scalable workflows that support compliance and program performance.
The ideal candidate brings extensive Medicare risk adjustment expertise, a strong understanding of CMS coding requirements, and experience translating complex coding guidelines into practical solutions for clinical teams.
This is an excellent opportunity for an experienced coding professional who enjoys working independently, advising healthcare leaders, and contributing to
Key Responsibilities
- Serve as a coding and risk adjustment subject-matter expert, providing guidance on ICD-10-CM coding, HCC capture, and Medicare Advantage documentation requirements.
- Conduct coding audits and clinical documentation reviews to evaluate accuracy, completeness, compliance, and opportunities for improvement.
- Audit existing coding staff and provide actionable feedback to strengthen coding quality and consistency.
- Partner with Nurse Practitioners, Physicians, RN Care Managers, and operational leaders to improve coding practices across clinical programs.
- Develop and implement coding workflows, policies, standard operating procedures (SOPs), and documentation guidelines aligned with CMS requirements.
- Design and deliver coding education, provider training, and practical reference materials for clinical teams.
- Identify missed HCC capture opportunities, documentation gaps, and coding trends to support accurate risk adjustment.
- Monitor coding quality metrics, risk adjustment performance, and regulatory updates, providing recommendations to leadership.
- Support risk adjustment data validation, encounter submission workflows, revenue integrity initiatives, and preparation for RADV and other compliance audits.
- Collaborate with internal teams and external clients to communicate coding performance, documentation findings, and opportunities for process improvement.
Required Qualifications
- Certified Risk Adjustment Coder (CRC) certification required.
- Minimum of 5 years of experience in Medicare risk adjustment coding, HCC coding, or clinical documentation improvement (CDI).
- Strong knowledge of ICD-10-CM coding guidelines, CMS-HCC models, and Medicare Advantage risk adjustment methodology.
- Experience reviewing clinical documentation and advising healthcare providers on coding accuracy and documentation best practices.
- Demonstrated ability to develop or deliver coding education, training, and quality improvement initiatives.
- Proficiency with electronic medical record (EMR) systems, coding tools, and documentation review processes.
- Strong analytical, organizational, and communication skills.
- Ability to work independently in a flexible, remote consulting environment.
Preferred Qualifications
- Certified Professional Coder (CPC) certification.
- Experience with risk adjustment coding and documentation in PACE (Program of All-Inclusive Care for the Elderly) programs, including CMS-HCC V22–V28 models.
- Background in value-based care, Medicare Advantage, population health, or complex care management.
- Familiarity with Comprehensive Diagnostic Assessments (CDAs), Health Risk Assessments (HRAs), Annual Wellness Visits (AWVs), and Transitional Care Management (TCM).
- Experience supporting RADV audits, coding compliance programs, and risk adjustment quality initiatives.
- Experience presenting coding performance findings and recommendations to clinical leadership or external clients.
- Experience working in a fast-paced, growing healthcare organization.
Engagement Details
This is a fully remote, part-time independent contractor (1099) opportunity with an anticipated commitment of approximately 5–20 hours per week. Hours and scope will be established collaboratively based on organizational needs, program priorities, and project requirements.
Compensation will be commensurate with experience and the agreed-upon scope of services.
Join Our Team
At Avail Health, you'll have the opportunity to apply your expertise in a meaningful way, collaborating with clinical and operational leaders to strengthen care delivery, improve documentation integrity, and support innovative healthcare programs.
If you're an experienced risk adjustment coding professional who enjoys solving complex challenges, building efficient processes, and making an impact in value-based care, we'd love to hear from you.
Originally posted on Himalayas