Senior Risk Adjustment Coder (HCC / Medicare Advantage)

Drive Accuracy. Influence Outcomes. Protect Revenue.

We are seeking a highly experienced Senior Risk Adjustment Coder to play a critical role in risk adjustment accuracy, audit readiness, provider education, and clinical documentation excellence.

Job Title:

Senior Risk Adjustment Coder

Location:

Newark, CA (Candidates must currently reside within approximately 45–65 miles of the Newark area due to onsite operational needs.)

Employment Type:

Full-Time (Direct Hire)

Salary Range:

$91,000 – $119,000 annually, based on experience, skills, and internal equity

About the Role:

We are seeking a senior-level Risk Adjustment professional to support a leading healthcare organization focused on accurate HCC capture, audit readiness, documentation integrity, and provider engagement.

This role is highly operational and collaborative in nature and is not a traditional production-only coding position. The ideal candidate will bring strong expertise across Risk Adjustment workflows, including:

• pre-visit reviews
• concurrent reviews
• retrospective audits
• documentation validation
• provider-facing education
• CMS-compliant HCC coding practices

This position works closely with clinicians, coding leadership, compliance teams, and operational stakeholders to improve documentation quality, RAF accuracy, and overall coding integrity.

Key Responsibilities:

• Perform Risk Adjustment coding and chart abstraction in alignment with CMS guidelines and Medicare Advantage Risk Adjustment models
• Conduct pre-visit chart reviews to identify suspect conditions, coding gaps, and documentation opportunities prior to patient encounters
• Perform concurrent and retrospective coding audits and validation reviews to ensure coding accuracy and compliance
• Identify opportunities for HCC capture, recapture, and suspecting workflows
• Review historical encounters, labs, and supporting clinical documentation to validate chronic condition capture
• Ensure documentation supports CMS-compliant coding standards and M.E.A.T. criteria (Monitor, Evaluate, Assess, Treat)
• Communicate documentation clarification opportunities and coding recommendations directly with providers and clinical teams
• Support provider-facing clinical documentation improvement (CDI) initiatives and coding education efforts
• Participate in provider onboarding, documentation education, and coding clarification discussions as needed
• Collaborate with coding, compliance, operational, and revenue cycle teams to improve coding accuracy and audit readiness
• Support documentation defensibility and compliance initiatives related to Risk Adjustment coding
• Stay current with CMS regulations, ICD-10 guidelines, HCC model changes, and Risk Adjustment best practices

Required Qualifications:

• Certified Professional Coder (CPC) and Certified Risk Adjustment Coder (CRC) required
• 5+ years of dedicated Risk Adjustment / HCC coding experience
• Strong knowledge of Medicare Advantage and CMS Risk Adjustment models

·       Experience with:

1. 1. pre-visit reviews
   2. concurrent reviews
   3. retrospective audits
   4. documentation validation
   5. suspecting workflows

• Strong understanding of HCC capture, recapture, RAF impact, and coding compliance principles
• Experience working directly with providers on documentation clarification and coding education
• Strong audit and documentation review sophistication
• Familiarity with EHR systems (Epic preferred) and coding/audit tools
• Excellent analytical, communication, and collaboration skills
• Ability to navigate provider conversations and documentation clarification discussions professionally

What We’re Looking For:

We’re looking for a detail-oriented and operationally mature Risk Adjustment professional who can balance coding accuracy, provider collaboration, audit defensibility, and documentation integrity in a fast-paced healthcare environment.

Ideal candidates will demonstrate:

• Strong provider-facing communication skills
• Independent workflow ownership and problem-solving ability
• Strong understanding of pre-visit and concurrent review workflows
• Ability to identify documentation gaps and coding opportunities effectively
• Compliance-focused coding judgment
• Comfort working cross-functionally with clinicians and operational teams
• Passion for improving documentation quality and patient risk capture

Work Model & Schedule:

• Primarily remote role with hybrid operational expectations
• Candidates must be comfortable attending:
  • Quarterly in-person team meetings
  • Ad hoc onsite clinic visits and operational meetings as needed
  • Potential next-day onsite requests based on business or provider support needs
• Strong preference for candidates within commuting distance to Newark, CA due to provider interaction and operational collaboration requirements
• Monday–Friday schedule
• Flexible start times between approximately 6:30 AM – 8:00 AM PST
• Typical workday ends around 4:00 PM PST

About Power Personnel:

Power Personnel is a trusted healthcare staffing and workforce solutions partner with a strong track record supporting leading health systems and organizations across California and nationwide.

With deep expertise across clinical, administrative, revenue cycle, and operational functions, we connect top healthcare talent with high-impact opportunities that drive quality care and operational excellence.

Our team is committed to a consultative, candidate-first approach — ensuring alignment not only with role requirements, but also long-term career goals.

Referral Bonus:

Refer a friend to referrals@powerpersonnel.com and earn a $500 referral bonus!
(Referral must complete 20 shifts to qualify.)