Risk Coder

Title: Certified Risk Coder

Reports to: Manager, Risk Coding

Classification: Individual Contributor

Location: Boston (Remote)

Job description revision number and date: 2.0, 01.06.2025

Organization Summary:

Community Care Cooperative (C3) is a 501(c)(3) non-profit, Accountable Care Organization (ACO) governed by Federally Quality Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We are a fast-growing organization founded in 2016 with 9 health centers and now serving hundreds of thousands of beneficiaries who receive primary care at health centers and independent practices across Massachusetts. We are an innovative organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners.

Job Summary:

The Certified Risk Coder will be a part of an emerging coding team and coding service that performs retrospective and prospective risk coding reviews and completes provider training for a group of outpatient primary care practices across Massachusetts. In so doing, the Certified Risk Coder will use knowledge of appropriate coding, combined expertise in claims submission processes to improve the accuracy of documentation. This work ultimately leads to a greater understanding of the patient’s complexity while ensuring accurate risk adjustment for patient care. The Certified Risk Coder has experience in risk adjustment, outpatient primary care and/or behavioral health condition coding, billing compliance, and coding quality assurance protocols. The person in this role will report to the Manager, Risk Coding, and interface with an internal team of Practice Transformation Managers, as well as staff at FQHCs.

Responsibilities:

• Serves as an expert on ICD-10-CM coding guidelines, AHA Coding Clinic Guidance and MassHealth Risk Adjustment guidance
• Completes record review with a high degree of familiarity with common EHRs, especially Epic, NextGen, Centricity, and eCW
• Assists in the compilation and delivery of project reports and facilitates provider-facing interactions
• Completes internal audits per quality assurance protocols
• Facilitates allowable modifications to the bill to ensure accuracy, involving extensive interaction with FQHC billing and operations staff departments
• Assists in chart preparation for providers in advance of appointments
• Communicates with provider education team on observed trends to improve documentation
• Utilizes population health reporting tools to assist in the identification of patients and conditions in need of review and improvement
• Identifies opportunities for FQHC risk score improvement
• Performs other duties as assigned

Required Skills:

The Certified Risk Coder must be innovative, comfortable with ambiguity, well-organized, and committed to moving quickly and collaboratively as a member of an emerging team within a fast-paced organization. They must communicate clearly and succinctly in writing and verbally across multiple tiers of the organization, from leadership to individual providers and health center staff. Additionally, they must have a strong commitment to quality assurance and exceptional customer service.

• 0-5 years of risk coding experience
• 0-5 years of medical billing experience in an outpatient setting, preferably in primary care, pediatrics, or behavioral health
• In-depth knowledge of medical terminology, anatomy, physiology, and disease process
• Knowledge of electronic health record systems: Epic, NextGen, Centricity, and eCW preferred
• Expertise in Medicaid and/or Medicare risk adjustment models
• Billing compliance expertise required
• Self-starter; exercises high degree of initiative, judgement, discretion and decision making to achieve objectives
• Familiarity with Excel
• Performs with great integrity and produces accurate work with close attention to detail, especially in the completion of final deliverables to internal and external stakeholders

Desired Other Skills:

• Familiarity with the MassHealth ACO program
• Familiarity with Federally Qualified Health Centers
• Experience with anti-racism activities, and/or lived experience with racism is highly preferred

Qualifications:

• Certified Risk Coding (CRC) Certification through AAPC required

** In compliance with Infection Control practices per Mass.gov recommendations, we require all employees to be vaccinated consistent with applicable law. **