It’s inspiring to work with a company where people truly BELIEVE in what they’re doing!

When you become part of the SECUR Team, you’ll realize it’s more than a job. It’s a mission. We’re committed to providing groundbreaking solutions for our clients' unique needs offering a wide variety of compassionate healthcare choices. Our employees make all the difference in our success!

hybrid remote/office. This role is responsible for validating clinical documentation, supporting provider education, engaging in provider relations, and ensuring compliant coding practices to reflect the true health status of our Medicare Advantage population.

Qualifications

Required:

• Certified coder (e.g., CPC, CRC, CCS, or equivalent).
• 3+ years of experience in clinical risk adjustment coding, preferably in a Medicare Advantage environment.
• Strong knowledge of HCC coding, ICD-10 guidelines, and CMS risk adjustment methodologies.
• Familiarity with HCC v24 (legacy model) and HCC v28 (new model), along with their financial and operational implications for health plans.
• Experience educating providers on documentation improvement related to risk coding.
• Familiarity with CMS data submission processes and encounter data requirements.
• High attention to detail and strong analytical skills.
• Excellent written and verbal communication skills.
• Understanding of the differences between HCC v24 and v28, including: Condition category mappings, deletions, and reclassifications. RAF score impact under the new model.

Preferred:

• Knowledge of STARS and Quality metrics.
• Background in clinical settings or nursing is a plus.
• Experience presenting to Joint Operations Committees (JOCs) or similar governance groups.

Duties and Responsibilities

1. Risk Adjustment Coding & Chart Review

• Perform retrospective and prospective chart reviews to identify, validate, and capture diagnoses relevant to CMS risk adjustment models (e.g., HCC).
• Identify undocumented or under-documented chronic conditions that meet CMS criteria and should be included to accurately reflect member risk.
• Ensure accurate coding in compliance with ICD-10, CMS guidelines, and internal standards.

2. Provider Education & Engagement

• Conduct provider training and one-on-one coaching sessions focused on proper clinical documentation and coding practices.
• Educate providers on the impact of documentation on risk scores, patient outcomes, and plan performance.
• Provide feedback and tools (e.g., coding tip sheets, documentation templates) to support documentation improvement.
• Develop and maintain strong provider relationships to encourage ongoing engagement and collaboration on coding and documentation initiatives.
• Partner with Provider Relations to address provider inquiries, resolve documentation issues, and ensure alignment with organizational goals.

3. CMS Data Submission Support

• Collaborate with internal data and IT teams to ensure accurate and timely submission of encounter data to CMS.
• Identify and resolve data submission issues, such as rejected encounters or diagnosis codes.
• Track and reconcile coding opportunities with successful CMS submissions.

4. Compliance & Quality Assurance

• Maintain a strong understanding of CMS regulations, HCC models, and coding updates.
• Participate in internal and external audits to validate coding accuracy and compliance.
• Support initiatives to improve the overall accuracy and integrity of clinical data submitted to CMS.

5. Clinical Documentation Analysis

• Analyze medical records, lab results, imaging reports, and specialist notes to extract clinically relevant diagnoses.
• Ensure all documented conditions meet MEAT (Monitor, Evaluate, Assess, Treat) criteria.
• Communicate trends or systemic issues in documentation to leadership for corrective action.

6. Cross-Department Collaboration

• Work closely with Quality, Care Management, Compliance, and Provider Relations teams to align risk adjustment goals with broader organizational objectives.
• Contribute coding expertise to quality initiatives, such as Stars improvement programs or care gap closures.
• Organize, develop, and deliver Joint Operations Committee (JOC) presentations, including performance updates, coding trends, and provider engagement outcomes.

7. Reporting & Documentation

• Maintain accurate records of all reviews, education sessions, and coding decisions.
• Generate reports on HCC capture trends, coding opportunities, and provider engagement metrics.
• Assist in the development of dashboards or presentations for leadership as needed.

Compensation Pay Range:

$73,915.89 - $110,874.35

This position requires consent to drug and/or alcohol testing after a conditional offer of employment is made, as well as on-going compliance with the Drug-Free Workplace Policy.