Senior Patient Accounting Specialist
INTEGRIS Health
Certified Risk Adjustment Coder
Habitat Health
full-time
Posted on:
Origin: • 🇺🇸 United States • California
Visit company websiteSalary
💰 $24 - $28 per hour
Job Level
Junior
About the role
- Review participant medical records and provider documentation to identify, validate, and code risk-adjustable diagnoses in accordance with CMS-HCC v24 and v28 guidelines.
- Ensure complete, accurate, and compliant ICD-10-CM coding with a primary focus on concurrent and retrospective reviews (with flexibility for pre-visit planning as needed).
- Draft and submit compliant provider queries to clarify documentation and support accurate coding.
- Track and follow through on open queries—engaging with providers, monitoring responses, and closing them out appropriately.
- Apply strong critical thinking skills to resolve complex documentation and coding scenarios.
- Maintain clear, professional communication with providers and internal teams to support documentation completeness.
- Stay current with CMS, OIG, and industry regulations related to risk adjustment and coding compliance.
- Support accurate and compliant documentation for PACE participants in a remote environment.
Requirements
- Active CRC (Certified Risk Adjustment Coder) required.
- Minimum of 1 year of experience in risk adjustment coding.
- In-depth knowledge of ICD-10-CM and CMS-HCC models v24 and v28.
- Hands-on expertise in both CMS-HCC v24 and v28 models and the ability to apply coding standards across multiple workflows.
- Demonstrated ability to work independently, stay organized, and follow through on tasks with minimal oversight.
- Strong written and verbal communication skills, with the ability to engage providers in a professional and solutions-oriented manner.
- High attention to detail and ability to critically analyze clinical documentation.
- Proficiency with electronic health records (EHR) and Microsoft Excel.
- Vaccination requirement: proof of vaccination or declination form and required masking while in participant locations; adherence to infection control and PPE standards.
- Aligns with our purpose and our values, and is excited about living those out in daily practice.
