Certified Risk Adjustment Coder

Role Scope:

We are looking for a Certified Risk Adjustment Coder who is passionate about supporting accurate and compliant documentation for our PACE participants. This role requires a self-starter who thrives in an independent, remote environment, with strong critical thinking skills and a drive to deliver the highest quality outcomes. The ideal candidate will have hands-on expertise in both CMS-HCC v24 and v28 models and the ability to apply coding standards across multiple workflows.

• 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

Qualifications:

• 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.

• 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.

• Aligns with our purpose and our values, and is excited about living those out in daily practice

Nice to have:

• Experience as a risk adjustment coder in PACE, long-term care, or complex care populations.

• Background in clinical documentation improvement (CDI) or coding quality assurance.

• Experience with Epic/OCHIN systems.

Compensation:

We take into account an individual’s qualifications, skillset, and experience in determining final salary. This role is eligible for medical/dental/vision insurance, short and long-term disability, life insurance, flexible spending accounts, 401(k) savings, paid time off, and company-paid holidays. The expected salary range for this position is $24-$27 hourly and is bonus eligible. The actual offer will be at the company’s sole discretion and determined by relevant business considerations, including the final candidate’s qualifications, years of experience, skillset, and geographic location.

Vaccination Policy, including COVID-19

At Habitat Health, we aim to provide safe and high-quality care to our participants. To achieve this, please note that we have vaccination policies to keep both our team members and participants safe. For covid and flu, we require either proof of vaccination or declination form and required masking while in participant locations as a safe as an essential requirement of this role. Requests for reasonable accommodations due to an applicant’s disability or sincerely held religious beliefs will be considered and may be granted based upon review. We also require that team members adhere to all infection control, PPE standards and vaccination requirements related to specific roles and locations as a condition of employment.

Our Commitment to Diversity, Equity, and Inclusion:

Habitat Health is an Equal Opportunity employer and is committed to creating a diverse and inclusive workplace. Habitat Health applicants are considered solely based on their qualifications, without regard to race, color, religion, creed, sex, gender (including pregnancy, childbirth, breastfeeding or related medical conditions), gender identity, gender expression, sexual orientation, marital status, military or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), or other status protected by applicable law.

Habitat Health is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Habitat Health will take steps to provide people with disabilities and sincerely held religious beliefs with reasonable accommodations in accordance with applicable law. Accordingly, if you require a reasonable accommodation to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact us at [email protected].

Beware of Scams and Fraud

Please ensure your application is being submitted through a Habitat Health sponsored site only. Our emails will come from @habitathealth.com email addresses. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission by selecting the ‘Rip-offs and Imposter Scams’ option: https://reportfraud.ftc.gov/#/.