From Home Optum Health Coding Risk Adjustment Jobs

Description

Who is Gather Health?

We are a new and growing healthcare organization with a unique and innovative approach to healthcare. Our mission is to improve lives and communities through socially supported primary care for older adults. Our innovative business model allows our clinicians to treat the whole patient - not just their clinical needs. We do this by having a dedicated care team that supports our clinicians by addressing our patients' social determinants of health and providing the highest quality of service possible. Our ultimate vision is creating generational health and equity for communities across the country, one patient at a time.

The Risk Adjustment Coding Specialist will play a pivotal role in supporting accurate and complete diagnosis documentation as part of Gather Health's commitment to value-based care under Medicare Advantage and ACO REACH contracts. Embedded within a collaborative, interdisciplinary team-including primary care providers, clinical support staff, and care coordination specialists-this role ensures that coding practices align with clinical realities, driving both quality outcomes and appropriate reimbursement.

With deep expertise in the CMS-HCC Risk Adjustment Payment Model (V28), Hierarchical Condition Category (HCC) and CPT coding, the Specialist will serve as a trusted partner to providers, offering 1:1 feedback, leading group education sessions, and identifying opportunities for documentation improvement. Through both remote and in-person collaboration, this role strengthens the connection between frontline care delivery and compliant, effective coding practices.

Duties & Responsibilities:

• Making sure that codes are assigned correctly and sequenced appropriately as per government and insurance regulations
• Complying with medical coding guidelines and policies
• Reviewing patients' charts and documents for verification and accuracy (retrospective, prospective and Concurrent Chart Review)
• Ensuring that all documented risk adjusted conditions or HCCs are compliantly supported via the MEAT criteria
• Maintaining productivity and quality standards as set by the company
• Communicating professionally with co-workers regarding clinical and reimbursement issues
• Reporting missing or incomplete documentation while working with the providers to fix documentation errors.
• Following up and clarifying any information that is not clear to PCPs.

Minimum Requirements:

• Two (2) + years previous experience as a certified professional coder
• One year of risk adjustment experience
• Certified Risk Adjustment Coding certificate (CRC) preferred
• Certified Professional Coder through the American Academy of Professional Coders (AAPC) or Certified Coding Specialist through the American Health Information Management Academy (AHIMA)
• Proficient computer skills, Microsoft Office Suite (Word, PowerPoint, Outlook, and Excel)
• Must live in the surrounding Boston area and willing to visit our four (4) centers regularly

Preferred Skills:

• AS degree in accounting, health care administration, finance, business, or related field preferred
• Able to multitask, prioritize, and manage time efficiently
• Self-motivated and self-directed; able to work without supervision
• Excellent verbal, written, and interpersonal communication skills

Gather Health delivers Social Primary Care to older adults. Through our unique and differentiated care model and proprietary technology, Gather Health's solution drives substantial care outcomes by addressing the whole person needs of our target demographic: older, dual eligible adults, the fastest growing government segment. To address the needs of these clinically and socially complex patients, Gather Health's Social Primary Care solution is comprehensive and wholistic in nature, encompassing care and community within the four walls of Gather Health Centers and in the homes of its patients.

Gather's model achieves superior care by individualizing care and is reinforced by a three-prong approach: a unique care model quarterbacked by PCPs and supported by multi-disciplinary care teams, tailored Social Care Plans that are led by Gather Guides and facilitated by deeply rooted community partners, and a proprietary "Tech Enabled Home Model."

Founded in 2022 and born out of the Healthcare Foundry Portfolio, Gather Health is addressing a $1 trillion market in primary care for older adults. Today, Gather Health operates in Massachusetts and is working with a multitude of payer partners on aligning value-based care economics to deliver integrated care. Gather's leadership team has a track record of building and scaling innovative primary care platforms focused on vulnerable populations, including VillageMD and Commonwealth Care Alliance. Gather has raised $30M backed by Maverick Ventures, Khosla, and HC9 Ventures.

We are committed to supporting every aspect of your life by offering a total rewards package designed to support your health, financial security, and work-life balance:

• Health: Comprehensive medical, dental, and vision with day-one eligibility
• Protection: Company-paid Life, Short-Term, and Long-Term Disability insurance
• Retirement: 401(k) with company match and immediate vesting
• Time Off: Generous PTO that increases with tenure and 11 paid company holidays
• Wellness: Employee Assistance Program (EAP) and supplemental benefit options

Gather Health is an Equal Opportunity Employer. All employment decisions are made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status, or any other basis as protected by federal, state, or local law.