Clinical Risk Adjustment Coder

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Job Description:

About Alpine Physician Partners

Alpine Physician Partners partners with independent physician groups to deliver coordinated, value-based care that improves outcomes and lowers the total cost of care. Our clinical and coding teams support providers with the accurate, compliant documentation and coding practices that make value-based care possible.

Position Summary

The Clinical Risk Adjustment Coder reviews medical records and provider documentation to identify, validate, and accurately code chronic conditions and diagnoses in accordance with Hierarchical Condition Category (HCC) risk adjustment models. This role plays a key part in ensuring accurate risk score capture, supporting provider education, and maintaining compliance with CMS and payer coding guidelines.

Key Responsibilities

- Review medical records, encounter notes, and provider documentation to identify and validate diagnosis codes relevant to HCC and other risk adjustment models.
- Conduct in-home or virtual health assessments with patients, evaluating and documenting chronic conditions to support accurate risk adjustment coding.
- Assign and verify ICD-10-CM codes in accordance with official coding guidelines, CMS risk adjustment requirements, and payer-specific policies.
- Conduct retrospective and prospective chart reviews to identify gaps in documentation and coding accuracy.
- Collaborate with providers and clinical staff to clarify documentation and support accurate capture of chronic conditions.
- Provide feedback and education to providers on documentation improvement opportunities related to risk adjustment coding.
- Monitor coding accuracy through internal audits and quality assurance reviews, identifying trends and recommending corrective action.
- Stay current on CMS and payer-specific risk adjustment methodology updates, including changes to HCC models and ICD-10-CM guidelines.
- Maintain strict compliance with HIPAA and all applicable privacy and security regulations when handling protected health information.
- Partner with quality, analytics, and compliance teams to support risk adjustment initiatives and reporting.
- Maintain and update patient data for long-term tracking and reporting.

Required Qualifications

- MD, DO, NP, PA, or equivalent medical degree/licensure required.
- Active coding certification required: CRC (Certified Risk Adjustment Coder), CPC, CCS, or equivalent through AAPC or AHIMA.
- Minimum 2 years of experience in medical coding, with direct experience in HCC or risk adjustment coding strongly preferred.
- Working knowledge of ICD-10-CM coding guidelines and CMS Hierarchical Condition Category (HCC) risk adjustment models.
- Strong understanding of medical terminology, anatomy, physiology, and disease processes.
- Proficiency with electronic health record (EHR) systems and coding software.
- Excellent attention to detail, analytical skills, and ability to work independently in a remote or hybrid environment.
- Strong written and verbal communication skills, including the ability to communicate coding findings to clinical staff.

Preferred Qualifications

- Experience in a value-based care, ACO, or managed care environment.
- Prior experience conducting provider education or documentation improvement training.
- Prior experience performing in-home health assessments or annual wellness visits.

Work Environment

This position combines remote or hybrid chart review work with patient assessments conducted either in-person in patients' homes throughout the Denver and Colorado Springs, CO areas or virtually. Reliable transportation is required for in-home visits, and reliable internet access and a secure home workspace are required for remote and virtual work in order to maintain compliance with HIPAA and data security standards.

Equal Employment Opportunity

Alpine Physician Partners is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. Employment decisions are made without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other status protected by applicable law.

Salary Range: