Risk Adjustment & Quality Coding Specialist

Job description

Community Clinic is a trusted regional healthcare system dedicated to delivering exceptional, whole-person care in a compassionate, professional, and welcoming environment. As we continue to grow across the region, we remain grounded in one belief: people matter. That includes our patients—and our team. Every employee plays a vital role in living out our promise: We care. You belong.
Job Summary
We are seeking a Risk Adjustment & Quality Coder to join our Springdale Admin team! The Risk Adjustment & Quality Coding Specialist is a highly specialized, standalone role within the Coding team. This individual owns the organization's risk adjustment coding process and serves as the primary bridge to the Clinical Quality Care Team. The specialist performs comprehensive CMS-HCC risk adjustment reviews, collaborates directly with the Quality Team to align on targeted metrics, and acts as the subject matter expert who educates and audits the general coding staff to ensure quality data is captured accurately across the department. The schedule for this position is remote/hybrid role, full-time, with a schedule Monday - Friday 8:00AM - 5:00 PM
Responsibilities
Risk Adjustment and Coding Ownership (40%)
• Serve as the dedicated coder responsible for reviewing medical records to capture, validate, and assign accurate ICD-10-CM codes for chronic conditions under the CMS-HCC model.
• Ensure full compliance with official coding guidelines and MEAT documentation criteria, managing the provider query process when clinical documentation lacks required specificity.
• Maintain maximum coding accuracy while balancing the unique dual-production and administrative needs of this program.

Quality Metrics Support & Strategy (25%)
• Meet regularly with the Quality Care Team to review organizational performance dashboards and determine which specific quality measures (HEDIS/Stars) will be actively tracked.
• Translate clinical quality initiatives into concrete coding practices, ensuring the department is set up to capture the precise data points required to close clinical care gaps.

Internal Education & Coding Support (20%)
• Educate the general coding staff on how to properly recognize and capture targeted quality codes during their standard workflow.
• Develop training materials, tools, and documentation workflows to simplify quality capture for the rest of the coding team.
• Provide ongoing regulatory updates and guidance regarding changes to risk adjustment models and quality specifications.

Quality Assurance & Internal Auditing (15%)
• Educate the general coding staff on how to properly recognize and capture targeted quality codes during their standard workflow.
• Develop training materials, tools, and documentation workflows to simplify quality capture for the rest of the coding team.
• Provide ongoing regulatory updates and guidance regarding changes to risk adjustment models and quality specifications.

Community Clinic Essential Competencies
• Service: Treats every patient and coworker with empathy, respect, and a genuine desire to help.
• Ownership: Takes responsibility for their actions, follows through on commitments, and upholds high standards even when no one is watching.
• Adaptability: Remains flexible, open to change, and willing to learn in order to meet the evolving needs of our patients, teams, and organization.
• Collaboration: Works together with openness and respect, shares information freely, and supports co-workers to provide seamless, high-quality care.
• Collaboration: Works together with openness and respect, shares information freely, and supports co-workers to provide seamless, high-quality care.
• Problem Solving: Approaches challenges with curiosity, finds practical solutions, and takes initiative to improve processes and patient experiences.

Role Specific Essential Skills/Competencies
• Autonomous Work Style: Ability to manage a multi-faceted workload independently without requiring daily supervision on program workflows.
• Strong Communication & Facilitation: Comfortable leading meetings with the Quality Team and explaining complex coding logic to peer coders.
• Analytical Problem-Solving: Ability to audit peer work objectively, spot errors, and design educational solutions to fix them.
• Training: A strong aptitude for peer mentoring, training, and teaching others about the nuances of medical coding.

Required Qualifications
• High School diploma or equivalent.
• 3+ years of professional medical coding experience2+ years of focused expertise in HCC/Risk Adjustment.
• Active, accredited coding credential with a risk adjustment specialty such as:
• CRC (Certified Risk Adjustment Coder).
• CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist)
• CPMA (Certified Professional Medical Auditor) – a strong asset
• Experience collaborating across departments (e.g., working with clinical quality teams, care managers, or clinic leadership).

Preferred Qualifications
• Graduation from an accredited Medical Coding certificate program or an Associate degree in Health Information Technology (HIT).
• Demonstrated experience training or conducting medical record audits.
• Bilingual ability in Spanish and English
• Previous experience in Community Health or an FQHC.

Why Work at Community Clinic?
• Be a part of a mission-driven organization committed to providing access to health-care to everyone in your community!
• Excellent Benefits Package including:
• Health, Vision, Dental and Life Insurance
• 403(b) Retirement plan (automatic employer contribution of 5% per paycheck!)
• Paid Time Off and Holidays
• Employee Discounts for Care

Remote/Hybrid Monday - Friday 8:00 AM - 5:00 PM
40 - Hours