Medicare Risk Adjustment Coder
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Job Summary
To support quality improvement initiatives, the full-time remote Provider Educator & Medicare Risk Adjustment Coder will monitor and collect Medicare Stars data, conduct medical record reviews, analyze findings, and prepare compliance documentation.
Key responsibilities
- Coordinates HEDIS and Star measure data collection using various resources
- Conducts data entry and review of Star measure data per NCQA and CMS specifications
- Identifies opportunities for improvement based on Stars data to support program initiatives
Required qualifications
- Bachelor's degree in a job-related field or equivalent work experience
- Professional certification in nursing, pharmacy, medical assistant, or related healthcare training
- Minimum 2 years of experience in managed care, quality improvement, or clinical settings
- Experience working with HEDIS standards and Medicare Advantage
- Familiarity with clinical terminology and medical records
Complete Job Description
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