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