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Risk Adjustment Coding Coordinator

Mass General Brigham Health Plan
United States, Massachusetts, Somerville
399 Revolution Drive (Show on map)
Dec 04, 2025
The Risk Adjustment Coder works to improve the coding and quality aspects of risk adjustment processes. In partnership with key stakeholders, supports management of oversight of vendors and continuously works to improve people, processes, and technology across the function. The position works to manage accurate and compliant coding practices, find opportunities for documentation improvement, optimize risk adjustment processes, and support revenue cycle management. Essential Functions -Actively contributes to the strategic direction for Risk Coding and collaborates with vendor partners to lead volume and ensure adherence to agreed upon SLAs. -Establishes KPIs for risk coding functions; ensures the implementation of action plans when performance does not meet expectations. -Communicates relevant changes in performance, market trends, healthcare delivery systems, and legislative initiatives impacting the execution of team goals to team(s). -Provides direction and oversight across the organization's Risk Coding methodology, performance, and workflows. -Monitors, implements, and contributes to financial planning provided by leadership to support a cost-effective Risk Coding strategy. -Leads the offshore volume for risk coding and ensures vendors are held to agreed-upon SLAs. -Develop and implement quality improvement initiatives; examples include conducting regular audits, educating coders/clinicians, and monitoring KPIs for improvements. -Conduct training and education sessions for healthcare providers and coding staff on risk adjustment coding requirements and best practices. -Performs other duties as assigned -Complies with all policies and standards Education Bachelor's Degree preferred Licenses and Certifications Certified Risk Adjustment Coder (CRC) certification Experience At least 1-2 years of experience in medical coding or risk adjustment coding required Knowledge, Skills, and Abilities In-depth knowledge of ICD-10, CPT, and HCPCS coding systems, particularly as they relate to risk adjustment. Strong analytical abilities to assess coding accuracy and identify areas for improvement. Excellent verbal and written communication skills for effective training and collaboration with clinical staff and coding teams. High level of accuracy and attention to detail in coding and documentation processes. Familiarity with healthcare regulations and guidelines related to risk adjustment and coding compliance. Working Conditions: This is a remote role that can be done from most US states. Local employees attend meetings 1x/month in the office. Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.