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Baystate Health

Operates regional hospitals and health services

HCC/RAF Coding Specialist

Clinical Support & Patient AdministrationConfirmed live in the last 24 hours
Full-timeSpringfield, MA, USA$89.6k - $121.8k

About the Job

Requirements

  • An associate's degree is required.
  • Current, active licensure as an RN, LPN, MD/DO, or Advanced Practice Provider is required.
  • At least three years of RN clinical experience or physician-trained clinical experience is required.
  • Strong clinical knowledge of chronic disease processes and condition management is required.
  • Knowledge of ICD-10 diagnosis coding principles and clinical documentation requirements is required.
  • Understanding of CMS HCC risk adjustment methodology and reimbursement concepts is required.
  • Proficiency with electronic medical records and Microsoft Office applications is required.
  • Strong organizational, analytical, and problem-solving abilities, including the ability to work independently, are required.
  • A driver's license is required.

Responsibilities

  • Review medical record documentation and abstract ICD-10 diagnosis codes to accurately capture patient complexity, severity of illness, and risk adjustment opportunities.
  • Identify, validate, and report missing, incomplete, inaccurate, or unsupported diagnoses in accordance with CMS HCC and coding guidelines.
  • Maintain and optimize patient problem lists by adding, updating, or removing diagnosis codes based on current clinical documentation.
  • Collaborate with physicians and advanced practice providers to clarify ambiguous or incomplete documentation and ensure coding accuracy.
  • Serve as a subject matter expert in HCC, RAF, and risk adjustment coding methodologies.
  • Educate providers and staff on documentation improvement opportunities, coding requirements, and risk adjustment best practices.
  • Analyze risk adjustment and population health reports to identify trends, educational needs, and reimbursement opportunities.
  • Support Medicare Annual Wellness Visit initiatives and other programs that improve patient outcomes, quality measures, and coding accuracy.
  • Assist with data collection, reporting, audits, and quality improvement initiatives related to documentation and coding practices.
  • Identify and communicate documentation deficiencies, coding concerns, and compliance-related issues.
  • Support onboarding activities for new patients to ensure accurate and complete documentation of chronic conditions and health maintenance needs.
  • Adhere to Baystate Health compliance standards, regulatory requirements, and coding guidelines.
  • Travel to practices throughout the Baystate Health system to conduct provider education, training sessions, and on-site documentation improvement initiatives.

Desired Qualifications

  • A bachelor's degree is preferred.
  • Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), Certified Coding Specialist (CCS), or a similar coding certification is preferred.
  • Experience with risk adjustment, HCC coding, population health, or value-based care initiatives is preferred.
  • Experience providing physician education related to documentation improvement and coding compliance is preferred.
  • Knowledge of Medicare Advantage, HEDIS, and quality performance programs is preferred.

About the Company

Baystate Health

Operates regional hospitals and health services

Baystate Health is a large healthcare organization serving western Massachusetts with about 13,000 employees and five hospitals that together house around 980 beds. It provides a wide range of patient care and community health services and aims to improve the health of people in its communities every day with a focus on quality, safety, value, and experience. Its work spans patient care from the bedside to education and workplace health, reflecting a community-first mission where treating people with dignity and equity matters. The organization positions itself as a major regional provider and economic driver, emphasizing accessible care and local impact. What sets Baystate Health apart is its scale in western Massachusetts, its integrated approach to care and community health, and its role as a local employer and leader in health outcomes. The goal is to make healthcare accessible and to continually improve health and wellness for the communities it serves.

Company size
5,001-10,000
Company stage
Grant
Total funding
$3.9M
Headquarters
Springfield, IL
Founded
1873

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