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Per Diem Hcc Risk Adjustment Coder Jobs in Massachusetts

Mass Advantage

Manager, Risk Adjustment

Worcester, MA · On-site

... coding validation) programs, ensuring complete, accurate, and compliant HCC documentation under the applicable CMS-HCC model (including V24 -V28 transition management). * Evaluate current vendor ...

US Tech Solutions

Medical Billing Coder

Wellesley, MA · Remote

$20.50 - $27.50/hr

... for HCC risk adjustment related activities including Medicare Advantage and Commercial Risk ... Collect and document chart and coding information as required for Commercial Risk Adjustment and ...

Community Care Cooperative

Risk Coder

Boston, MA · On-site

$24.75 - $32.75/hr

The Certified Risk Coder has experience in risk adjustment, outpatient primary care and/or ... Completes internal audits per quality assurance protocols * Facilitates allowable modifications to ...

Community Care Cooperative

Risk Coder

Boston, MA · On-site

$50K - $57K/yr

The Certified Risk Coder has experience in risk adjustment, outpatient primary care and/or ... Completes internal audits per quality assurance protocols * Facilitates allowable modifications to ...

Lynn Community Health Center

Medical Coder II

Lynn, MA · On-site

$22.20 - $29.88/hr

Serves as a resource for clinical teams to address risk adjustment and medical coding guidelines ... HCC or DxCG coding experience. * Advanced skills with Microsoft applications which may include ...

Westborough Behavioral

Coder - Per Diem

Westborough, MA · On-site

$19.25 - $25.75/hr

Per diem Job Summary: The Medical Coder complies with all legal requirements regarding coding procedures and practices. Conducts audits and coding reviews to ensure all documentation is accurate and ...

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Per Diem Hcc Risk Adjustment Coder jobs near you
Infographic showing various Per Diem Hcc Risk Adjustment Coder job openings in Massachusetts as of August 2026, with employment types broken down into 1% As Needed, 88% Full Time, 8% Part Time, and 3% Contract. Highlights an 88% Physical, 4% Hybrid, and 8% Remote job distribution.

Manager, Risk Adjustment

Central Mass Health LLC

Worcester, MA • On-site

$90K/yr

Full-time

Re-posted 23 days ago

Job description

Mass Advantage is a Medicare Advantage health plan, located in the heart of Worcester County, headquartered in Worcester MA. Mass Advantage is owned and designed by UMass Memorial Health providers with their patients' needs in mind.
We are looking for a Manager of Risk Managment to oversee Mass Advantages's full suite of Risk Adjustment activities. This position is responsible for the strategy, execution and performance of Medicare risk adjustment programs, infrastructure and systems to meet business objectives, revenue expectations, management of external vendors, interaction with Providers, regulatory audits, and compliance with CMS regulations. The Manager of Risk Management is also responsible for analysis, projections, and assessment of Medicare revenue initiatives for senior products; leading and coordinating enterprise risk adjustment initiatives, working with the necessary areas of Mass Advantage and UMass Memorial Health Operations as well as vendor partners.
Essential Duties and Responsibilities:
Program Strategy & Execution
  • Own end-to-end RA strategy across prospective (point-of-care capture, suspecting, provider workflows) and retrospective (chart review, coding validation) programs, ensuring complete, accurate, and compliant HCC documentation under the applicable CMS-HCC model (including V24 -V28 transition management).
  • Evaluate current vendor performance, renegotiating or sunsetting SOWs where internal capability is superior.
  • Serve as the plan-side counterpart to UMMH CDI, HIM, and Coding leadership, coordinating with the CMO's office to embed documentation workflows into Epic-based clinical practice rather than layered on top of it.
  • Partner with Network and Clinical Services to design provider-facing education, scorecards, and incentive structures that drive documentation accuracy without creating coding-driven behavior.
  • Develop provider-level performance reporting that is transparent, defensible, and actionable.

RADV, Audit & Compliance
  • Lead RADV audit readiness and response, including medical record retrieval, validation, submission strategy, and cross-functional coordination with Legal, Compliance, and Finance to mitigate financial and compliance risk.
  • Maintain a comprehensive QA program covering RADV, OIG, and internal audits - monitoring the work of internal coders, contracted vendors, and provider documentation alike.
  • Own encounter data integrity, including EDPS submission accuracy, RAPS/EDPS reconciliation, and error resolution.

Analytics, Finance & Bid Support
  • Build and maintain the RA analytics layer - dashboards, KPIs, and provider/member-level reporting that drive continuous improvement in risk score accuracy, coding yield, and program ROI.
  • Partner with Actuarial and Finance on bid development, producing defensible risk score projections, trend analysis, and revenue assumptions grounded in population severity and program performance.
  • Communicate results to executive and board audiences through clear reports, dashboards, and presentations.

Program & Team Leadership
  • Set departmental goals, budgets, and tactical plans aligned with enterprise strategy and financial targets.
  • Other duties may be assigned as needed.

* Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
Requirements
  • Bachelor's degree in a relevant field; Master's (MBA, MHA, MPH) preferred.
  • Registered Nurse (RN) desired.
  • CRC (Certified Risk Adjustment Coder), CPC, or CCS certification preferred.
  • 7+ years in Medicare Advantage risk adjustment, with at least 3 years in a plan-side role (not solely provider-side or vendor-side).
  • Direct, hands-on RADV experience - working fluency with the CMS-HCC model, including the V24-V28 transition and its financial implications.
  • Demonstrated experience managing or transitioning RA vendors (coding, chart retrieval, in-home assessment).
  • Strong analytical skills: able to interrogate data directly in SQL, Power BI, or Tableau, or to spec analytics requirements with precision.+
  • Strong Microsoft Office skills (Word, Outlook, Excel and PP).

Salary Description
Starting at $90K

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