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Certified Risk Adjustment Coder Jobs in Boston, MA

Community Care Cooperative

Risk Coder

Boston, MA · On-site

$50.22K - $57.75K/yr

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 ...

Point32Health

Risk Adjustment Consultant

Canton, MA · On-site

Support the Risk Adjustment department in efforts to assess additional diagnosis coding ... Qualifications - what you need to perform the job Education, Certification and Licensure * Bachelor ...

Point32health

Risk Adjustment Consultant

Canton, MA · On-site

Support the Risk Adjustment department in efforts to assess additional diagnosis coding ... Qualifications - what you need to perform the job Education, Certification and Licensure * Bachelor ...

US Tech Solutions

Medical Billing Coder

Wellesley, MA · Remote

$20.50 - $27.50/hr

Collect and document chart and coding information as required for Commercial Risk Adjustment and ... ICD -9/ICD-10 certification required. * Experience in performing HEDIS chart abstractions;

National Grid

Risk Management Specialist

Waltham, MA · Hybrid

$102K - $119K/yr

... Code 2024. Assist with the implementation of effective risk management activities aligned with ... Certified Professional (ERMCP), Certified Risk Manager (CRM), Certified Risk Management ...

National Grid

Risk Management Specialist

Waltham, MA · On-site

$102K - $119K/yr

... Code 2024. Assist with the implementation of effective risk management activities aligned with ... Certified Professional (ERMCP), Certified Risk Manager (CRM), Certified Risk Management ...

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How much do certified risk adjustment coder jobs pay per hour?

As of May 28, 2026, the average hourly pay for certified risk adjustment coder in Boston, MA is $31.72, according to ZipRecruiter salary data. Most workers in this role earn between $23.70 and $31.49 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Certified Risk Adjustment Coder, and why are they important?

To thrive as a Certified Risk Adjustment Coder, you need expertise in medical coding, a thorough understanding of ICD-10-CM guidelines, and certification such as CRC (Certified Risk Adjustment Coder). Familiarity with coding software, electronic health records (EHRs), and risk adjustment models like HCC is typically required. Attention to detail, analytical thinking, and strong communication skills help ensure accurate code assignment and effective collaboration with healthcare providers. These skills and qualifications are crucial for capturing precise patient data, which directly impacts healthcare reimbursement and compliance.

What are some common challenges Certified Risk Adjustment Coders face, and how can they overcome them?

Certified Risk Adjustment Coders often encounter challenges such as staying current with evolving coding guidelines and accurately interpreting complex medical records. To overcome these difficulties, coders should regularly participate in ongoing education, leverage resources from professional organizations, and collaborate closely with providers to clarify documentation. Maintaining a strong attention to detail and utilizing coding software tools can also help minimize errors and improve coding accuracy. Engaging in peer reviews within the team can further enhance consistency and knowledge sharing.

What is a Certified Risk Adjustment Coder?

A Certified Risk Adjustment Coder is a professional who specializes in reviewing and coding medical records to ensure accurate documentation of diagnoses for risk adjustment purposes. These coders play a crucial role in healthcare reimbursement, especially for Medicare Advantage and other risk-adjusted health plans. They analyze patient records using ICD-10-CM codes to help healthcare organizations receive appropriate compensation based on the severity of patient conditions. Certified Risk Adjustment Coders typically hold certifications such as the CRC from the AAPC, demonstrating their expertise in this specialized field.

What is the difference between Certified Risk Adjustment Coder vs Certified Medical Coder?

AspectCertified Risk Adjustment CoderCertified Medical Coder
CertificationsRequires risk adjustment-specific credentials like RAC, CRC, or CPC-RRequires CPC or CCS certifications
Work EnvironmentPrimarily in health insurance, risk adjustment, and payer settingsHospitals, clinics, physician offices, and outpatient facilities
Industry UsageUsed mainly in health insurance and risk adjustment programsUsed across healthcare providers for medical coding and billing

The Certified Risk Adjustment Coder specializes in coding for risk adjustment programs within health insurance, focusing on accurate documentation for reimbursement. In contrast, the Certified Medical Coder works across various healthcare settings, primarily coding diagnoses and procedures for billing. While both roles require coding certifications, their focus areas and work environments differ significantly.

What are popular job titles related to Certified Risk Adjustment Coder jobs in Boston, MA? For Certified Risk Adjustment Coder jobs in Boston, MA, the most frequently searched job titles are:
What job categories do people searching Certified Risk Adjustment Coder jobs in Boston, MA look for? The top searched job categories for Certified Risk Adjustment Coder jobs in Boston, MA are:
Certified Risk Adjustment Coder jobs near you

Risk Coder

Community Care Cooperative

Boston, MA • On-site

$50.22K - $57.75K/yr

Full-time

Posted 26 days ago

Job description

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. **