Based in Akron, Ohio, SummaCare provides Medicare Advantage, individual, family, and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5‑Star rating for 2025 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits.
Position Summary
Performs chart retrieval, medical record review, HCC identification and data quality oversight for risk mitigation and revenue recovery for both Medicare and ACA services. Assists in the development and management of activities in support of HCC coding while ensuring compliant practices for revenue management and reducing risk. Helps in the preparation with all Risk Adjustment Data Validations (RADV) audits as well as serving as the CMS liaison for coding questions/issues. Determines adequacy and correctness of physician diagnosis/documentation as it relates to risk adjustment.
Requirements
Formal Education Required
Associate degree or equivalent combination of education and/or experience.
Experience & Training Required
Five (5) years experience to include leadership experience, medical chart reviews, risk adjustment experience with in‑depth working knowledge of CPT coding, ICD‑9 and ICD‑10 coding, medical terminology, and solid working knowledge of HCC coding.
Other Skills, Competencies and Qualifications
Ability to obtain Certified Risk Adjustment Certification (CRC) from the American Academy of Professional Coders (AAPC) within 6 months of hire.
Demonstrate knowledge of Microsoft Office suite and other software for electronic processing of medical records.
Maintains up‑to‑date knowledge on risk adjustment HCC processing concerning ICD‑9 and ICD‑10 coding guidelines.
Maintain current knowledge of medical coding concepts, techniques and principles in regards to risk management activities.
Understands medical chart review processes and effectively translate the associated business needs into appropriate solutions and actions.
Demonstrate strong attention to detail and understanding the medical record in order to determine the appropriate health conditions (correct diagnosis codes) that should be submitted as additions or redactions for risk adjustment.
Organize and manage time to accurately complete tasks within designated periods in fast‑paced environment.
Maintain current knowledge of, comply with regulatory, and company policies and procedures.
Maintain confidentiality of patient and business information.
Flexible: ability to adjust work hours to meet business demands.
Level of Physical Demands
Sit for prolonged periods.
Bend, stoop, and stretch.
Lift up to 20 pounds.
Manual dexterity to operate computer, phone, and standard office machines.
Compensation
$25.54/hr - $38.32/hr. The salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location, are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical.
Benefits
Basic Life and Accidental Death & Dismemberment (AD&D)
Supplemental Life and AD&D
Dependent Life Insurance
Short‑Term and Long‑Term Disability
Accident Insurance, Hospital Indemnity, and Critical Illness
Retirement Savings Plan
Flexible Spending Accounts – Healthcare and Dependent Care
Employee Assistance Program (EAP)
Identity Theft Protection
Pet Insurance
Education Assistance
Daily Pay
Equal Opportunity
Equal Opportunity Employer/Veterans/Disabled
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