Alpine Physician Partners

Risk

• Develop and execute Alpine’s enterprise-wide risk adjustment coding strategy aligned with organizational value-based care goals
• Design scalable frameworks for HCC coding operations, documentation improvement, and provider education across diverse care settings
• Partner with executive leadership to forecast, plan, and evaluate annual risk adjustment performance
• Lead day-to-day management of coding operations, including in-house coders, vendors, chart retrieval processes, and auditing
• Oversee timely and accurate capture of HCCs for MA, MSSP, and ACO Reach risk programs
• Implement processes that improve provider documentation completeness and clinical accuracy
• Collaborate closely with physicians, practice leaders, and clinical teams to drive documentation improvement
• Build and deliver education programs, coaching, and workflow enhancements that reduce burden and elevate documentation quality
• Serve as the go-to expert for coding issues, regulatory guidance, and clinical documentation best practices
• Partner with data/analytics teams to enhance risk adjustment dashboards, reporting, and EMR-driven coding solutions
• Evaluate and manage technology solutions that support prospective and retrospective coding workflows
• Maintain strict adherence to CMS, HHS, OIG, and payer-specific risk adjustment policies
• Lead internal and external audit programs, including RADV preparedness, vendor monitoring, and coding quality assurance
• Recruit, develop, and retain a high-performing team of coders, auditors, educators, and analysts
• Foster a culture of accountability, service excellence, and continuous improvement
• Manage budgets, resource allocation, and operational KPIs

Director, Risk Adjustment Coding

Medical Billing and Coding

• Review and analyze patient medical records to assign appropriate ICD-10, CPT, and HCPCS codes
• Ensure coding accuracy and compliance with federal regulations, payer policies, and internal standards
• Collaborate with healthcare providers to clarify documentation and resolve coding discrepancies
• Submit coded data to billing systems to initiate insurance claims and support reimbursement
• Maintain and update patient data for long-term tracking and reporting
• Participate in audits and quality reviews to ensure coding integrity
• Stay current with changes in medical coding guidelines, CMS updates, and payer requirements
• Support internal compliance and contribute to external audit readiness

Certified Embedded Medical Coder

• Conduct comprehensive retrospective and/or prospective risk adjustment chart reviews in accordance with CMS guidelines
• Identify, validate, and capture appropriate HCCs supported by documentation, including chronic condition monitoring and MEAT criteria
• Ensure diagnosis coding is accurate, specific, and compliant with ICD-10-CM and Medicare requirements
• Document findings clearly and consistently within designated systems and tools
• Support timely and accurate submission of risk adjustment codes through established workflows
• Identify documentation gaps, unsupported diagnoses, or compliance risks and escalate appropriately
• Achieves and maintains coding accuracy levels greater than 95%
• Provide clear, actionable feedback to providers and practice staff based on chart review findings
• Support structured education efforts focused on common documentation opportunities, trends, or errors identified through chart reviews
• Reinforce best practices for documentation and coding through targeted training sessions, written guidance, or job aids as needed
• Serve as a subject matter resource for questions related to risk adjustment documentation and coding standards
• Partner with clinical, operational, and analytics teams to support reporting accuracy and data integrity
• Identify recurring trends or systemic issues impacting documentation and coding accuracy
• Contribute to workflow improvements and standardization efforts related to risk adjustment processes
• Stay up to date with changes in coding, risk adjustment, and Medicare regulations

Director, Risk Adjustment Coding

Certified Embedded Medical Coder

Risk Adjustment Coder