Risk Adjustment Coding Jobs in Spring, TX (NOW HIRING)

Apex Health Solutions is seeking a high-caliber Practice Performance Manager (PPM) to serve as a strategic advisor and on-the-ground transformation catalyst across our growing network of value-based care partnerships. This mission-critical role sits at the intersection of clinical quality improvement, risk adjustment, population health analytics, and practice operations—empowering primary care physicians, specialist groups, and entire care teams to achieve sustainable, measurable performance gains.

The PPM functions as both a trusted clinical partner and a skilled change management professional, delivering direct practice support—on-site and remotely—to drive improvement across key performance domains including HEDIS/Stars quality measures, HCC capture rates, Annual Wellness Visit (AWV) completion, care gap closure, and EHR workflow optimization. This individual will work at the forefront of Apex's value-based care delivery model, translating data into action and building lasting clinical and operational capabilities within partner practices.

The ideal candidate combines deep clinical or quality improvement expertise with strong interpersonal influence skills—capable of coaching frontline staff, engaging physicians, and presenting data-driven strategies to practice leadership. If you are passionate about transforming how healthcare is delivered and measured, this role offers a unique opportunity to make a direct, lasting impact on patient outcomes at scale.

Clinical Quality

Drive measurable improvement in HEDIS, eCQM, Stars ratings, and quality gap closure rates across assigned practices

Risk Adjustment

Improve HCC capture accuracy and RAF score accuracy through targeted clinical documentation improvement (CDI) education and workflow implementation

Operational Efficiency

Optimize EHR workflows, billing practices, and administrative processes to reduce friction and improve throughput

Practice Transformation

Build lasting team-based care competencies and data-driven decision-making capabilities within partner organizations

Practice Partnership & Planned Care Model Development

• Establish and sustain trusted, high-value advisory relationships with physician practices, serving as the primary point of contact for all value-based care performance initiatives.

• Co-design and implement a planned care model within each practice, integrating administrative, financial, and clinical systems to drive coordinated, proactive patient management and improved outcomes.

• Identify and prioritize root causes of financial and quality underperformance; develop and execute targeted improvement strategies with clearly defined accountability metrics for each practice site.

EHR Optimization & Workflow Redesign

• Lead comprehensive workflow design and redesign efforts with practice teams, encompassing EHR optimization, clinical documentation standardization, coding practices, and billing accuracy.

• Conduct financial analyses and performance improvement assessments, translating findings into actionable workflow modifications that yield measurable efficiency gains.

• Evaluate current-state EHR utilization across assigned practices and deliver tailored optimization recommendations to maximize data capture quality, billing compliance, and care coordination.

Clinical Documentation Improvement (CDI)

• Partner with clinicians to improve clinical documentation accuracy and specificity, with a focus on HCC (Hierarchical Condition Category) capture, chronic disease coding, and annual risk adjustment initiatives.

• Conduct structured chart reviews, deliver real-time feedback, and facilitate targeted education sessions to improve the completeness and accuracy of clinical records supporting risk adjustment accuracy.

• Serve as a subject matter expert on risk adjustment methodologies, ensuring clinical teams understand the connection between documentation quality, RAF (Risk Adjustment Factor) scores, and overall contract performance.

Population Health Analytics & Data-Driven Performance Management

• Leverage population health tools, EHR-based dashboards, and payer-provided data sets to support practices in identifying care gaps, stratifying patient risk panels, and prioritizing outreach efforts.

• Coach practice leadership and clinical staff to independently interpret quality metric reports—including HEDIS measures, Stars scores, and cost-of-care analytics—and translate insights into sustainable process improvements.

• Present data-driven performance reports to practice leaders and senior stakeholders, highlighting trends, gaps, and progress toward VBC contract benchmarks with clear improvement targets.

Physician & Staff Engagement

• Build and maintain collegial, trust-based relationships with physicians, advanced practice providers, and clinical staff to facilitate meaningful and sustained behavioral change in support of VBC goals.

• Develop and deliver customized education programs, resources, and toolkits to build internal clinical and operational capabilities around team-based care, patient engagement, and quality improvement.

• Engage directly with patients as appropriate to schedule Annual Wellness Visits (AWVs), facilitate specialist referrals, and support patient navigation—contributing directly to quality metric performance.

Training, Tools & Interdisciplinary Collaboration

• Develop, implement, and continuously refine training materials, project plans, and practice transformation toolkits used to support onboarding, ongoing education, and performance sustainment.

• Collaborate effectively across interdisciplinary teams including clinical implementation, analytics, research, support services, and medical record retrieval to ensure a cohesive and coordinated practice support model.

• Champion a culture of continuous quality improvement by modeling data-informed decision-making, collegial communication, and collaborative problem-solving with practice partners and internal colleagues alike.

Education & Experience

• Bachelor's Degree in Healthcare Administration, Nursing, Health Informatics, Business, or a related field required; advanced degree preferred. A combination of equivalent education and five (5) or more years of directly relevant experience will be considered in lieu of a degree.

• Minimum three (3) years of hands-on experience with Electronic Medical Record (EMR) / Electronic Health Record (EHR) systems, including demonstrated proficiency in system operations, workflow design, optimization, and implementation.

• Minimum three (3) years of progressive experience in one or more of the following: medical practice management, clinical program development, healthcare quality analytics, clinical transformation, or quality improvement (QI) initiatives within a value-based care or managed care environment.

Required Credentials (One or More)

• Certified Risk Adjustment Coder (CRC) — demonstrates expertise in HCC methodology and risk adjustment documentation standards

• Certified Professional Coder (CPC) — demonstrates proficiency in medical coding compliance and billing accuracy

Preferred Credentials (One or More)

• Certified Professional in Healthcare Quality (CPHQ) — demonstrates competency in quality improvement methodologies and performance measurement

• Licensed Vocational Nurse (LVN) or equivalent clinical licensure — provides direct clinical credibility in practice settings

Knowledge, Skills & Competencies

• Demonstrated knowledge of value-based care models, including ACO structures, shared savings programs, risk-based contracting, and quality performance metrics (HEDIS, Stars, CAHPS, etc.)

• Strong proficiency in data analysis and the ability to translate complex quality and claims data into clear, actionable practice-level recommendations

• Exceptional interpersonal and communication skills with a proven ability to build trust, navigate complex stakeholder relationships, and drive behavioral change across diverse clinical environments

• Experience with clinical documentation improvement (CDI), risk adjustment concepts, and HCC coding education strongly preferred

• Proficiency in Microsoft Office Suite (Excel, PowerPoint, Word, Teams) and familiarity with population health management platforms and/or EHR reporting modules

• Self-directed, highly organized, and capable of managing a portfolio of multiple practice relationships simultaneously with minimal supervision

• Willingness and ability to travel within the assigned geographic region for on-site practice visits as needed

Apex Health Solutions is a technology-enabled management services organization (MSO) purpose-built to advance value-based care. We partner with physician groups, health systems, and payers to accelerate the transition from fee-for-service to high-performing, value-based contracts—delivering measurable improvements in quality, risk accuracy, and total cost of care. Our tagline, Climb Higher, Faster, reflects our commitment to helping provider organizations achieve sustainable performance at scale.

At Apex Health Solutions, we believe that the future of healthcare is value-based—and that meaningful, lasting change happens at the practice level. As a Practice Performance Manager, you will be at the center of that transformation, equipped with best-in-class data tools, dedicated interdisciplinary support, and the autonomy to drive real impact.

• Purpose-driven mission: Directly improve patient outcomes and quality of care for communities across your region

• Innovative environment: Work at the cutting edge of value-based care with access to industry-leading analytics platforms and data-driven performance tools

• Collaborative culture: Partner with a team of experienced clinical, analytical, and operational professionals who are equally committed to practice transformation

• Career growth: Grow your expertise within a rapidly expanding organization at the forefront of healthcare's shift to value