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Seasonal Hcc Risk Adjustment Coding Jobs (NOW HIRING)

Strive Health

Manager, Coding Operations

Denver, CO · On-site

Works closely with Director of Risk Adjustment Coding operations and coding leads to identify HCC and ProFee coding trends or issues for providers and team members. * Provides additional oversight of ...

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Seasonal Hcc Risk Adjustment Coding information

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

To thrive as a Seasonal HCC Risk Adjustment Coder, you need a strong understanding of ICD-10-CM coding, risk adjustment methodologies, and a certification such as CPC, CRC, or CCS. Proficiency in coding software, electronic health records (EHRs), and risk adjustment platforms is typically required. Attention to detail, analytical thinking, and strong organizational skills help ensure accuracy and compliance in reviewing medical records. These skills are essential to accurately capture patient risk profiles, support healthcare reimbursement, and maintain regulatory compliance.

What are the most common challenges faced by professionals in Seasonal HCC Risk Adjustment Coding roles, and how can they be managed?

Seasonal HCC Risk Adjustment Coders often face the challenge of managing high volumes of medical records within tight deadlines, especially during peak audit or submission periods. Ensuring coding accuracy and compliance with evolving CMS guidelines can also be demanding, as even minor errors may impact reimbursement and risk scores. Staying organized, regularly participating in training updates, and leveraging coding software tools can help manage workloads and maintain accuracy. Collaborating closely with clinical teams and other coders is vital for clarifying documentation and sharing best practices.

What is a Seasonal HCC Risk Adjustment Coder?

A Seasonal HCC Risk Adjustment Coder is a healthcare professional who reviews medical records to identify and code diagnoses that impact risk adjustment scores, typically during peak periods such as the Medicare Advantage sweep season. HCC stands for Hierarchical Condition Category, a coding system used by Medicare to predict healthcare costs based on patient diagnoses. These coders ensure accurate documentation, which directly affects insurance reimbursement and compliance. Seasonal roles are common due to the cyclical nature of risk adjustment reporting deadlines.

What is the difference between Seasonal Hcc Risk Adjustment Coding vs Hcc Risk Adjustment Coding?

AspectSeasonal Hcc Risk Adjustment CodingHcc Risk Adjustment Coding
CredentialsCertifications in coding and risk adjustmentCertifications in coding and risk adjustment
Work EnvironmentHealthcare facilities, insurance companies, remoteHealthcare facilities, insurance companies, remote
Industry UsageUsed seasonally for specific risk adjustmentsUsed year-round for ongoing risk management
Search IntentUnderstanding seasonal coding differencesGeneral risk adjustment coding practices

Seasonal Hcc Risk Adjustment Coding focuses on coding practices during specific times of the year, often related to seasonal health trends. In contrast, Hcc Risk Adjustment Coding involves continuous coding to manage patient risk profiles throughout the year. Both roles require similar certifications and work environments but differ mainly in their temporal focus and application.

More about Seasonal Hcc Risk Adjustment Coding jobs
What cities are hiring for Seasonal Hcc Risk Adjustment Coding jobs? Cities with the most Seasonal Hcc Risk Adjustment Coding job openings:
What are the most commonly searched types of Hcc Risk Adjustment Coding jobs? The most popular types of Hcc Risk Adjustment Coding jobs are:
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What job categories do people searching Seasonal Hcc Risk Adjustment Coding jobs look for? The top searched job categories for Seasonal Hcc Risk Adjustment Coding jobs are:
Seasonal Hcc Risk Adjustment Coding jobs near you
Infographic showing various Seasonal Hcc Risk Adjustment Coding job openings in the United States as of May 2026, with employment types broken down into 77% Full Time, 21% Part Time, and 2% Contract. Highlights an 99% Physical, and 1% Hybrid job distribution.
Director of Risk Adjustment

Director of Risk Adjustment

Baystate Health

Springfield, MA • On-site

Full-time

Posted 14 days ago

Baystate Health rating

6.5

Company rating: 6.5 out of 10

Based on 137 frontline employees who took The Breakroom Quiz

593rd of 864 rated healthcare providers

Job description

Summary:

Location: Monarch Place; Springfield MA (MA & CT candidates only)

Schedule: Monday-Friday; fulltime; 40hrs.

Job Responsibilities:

  • Develops and implements risk adjustment strategy, policies and standard operating procedures
  • Collaborates with physicians, mid-level providers, other personnel, including coding experts, in risk adjustment review of the medical record
  • Serves as Health New England's ambassador in the Risk Adjustment Community
  • Works with industry on best practices for risk adjustment
  • Manages, measures, and evaluates performance of Health New England's risk adjustment vendors
  • Manages all data submission requirements
  • Prepares risk adjustment training programs for network physicians, mid-level providers, and plan personnel
  • Ensures that all risk adjustment related activities are compliant with CMS/ACA and state requirements
  • Serves as the risk adjustment compliance point of contact for HNE's Compliance Department
  • Collaborates with data management personnel in the appropriate formatting and methodology of risk adjustment analysis and related reporting
  • Develops productivity standards for risk adjustment auditing of claims or medical records
  • Collaborates with the Provider Relations Department to provide coding and risk adjustment education and resource information to network providers
  • Conducts educational events as necessary
  • Participates in administrative team's preparation of Medicare Advantage annual bids risk adjustment determination
  • Maintains expert knowledge of AMA's Coding systems, including ICD-9 & 10 diagnostic, CPT, HCPCS codes and any national updates or revisions of medical diagnostic, procedural, or medical supply coding
  • In collaboration with Plan management, participates in regulatory review and/or audit of submitted claims risk adjustment coding
  • Develops risk adjustment training materials for network providers, plan personnel and prospective network providers
  • Maintains working knowledge of Plan information management systems
  • Collaborates with the Managed Care Data Systems personnel in the development of reports and/or customized applications utilized for risk adjustment data analysis and reporting
  • Establishes business and functional requirements needed to define technology/systems platform
  • Creates executive level reports and performance metrics to keep Health New England up-to-date on risk adjustment
  • Manages, trains, coaches and develops staff

Minimally Required Education

Bachelor's degree in a related field.

Preferred Education

Master's degree in healthcare administration, public health, health informatics, population health, or a related healthcare field.

Professional certification such as Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), or similar coding credential.

Minimally Required Experience

7-10 years of experience in an HMO or MCO with direct HCC risk adjustment experience.

At least 2 years of management experience.

Experience with medical claims review, coding, or utilization management.

Knowledge of CMS risk adjustment methodologies and ICD-9/ICD-10 coding.

Preferred Experience

Experience in population health analytics and risk adjustment strategy.

Experience across multiple lines of business including ACA, Medicare Advantage (MA), and Medicaid models.

Certification:

Ability to obtain relevant coding or risk adjustment certification within a reasonable timeframe if not already held.

Education:

Bachelors Degree (Required)

Certifications:

Ambulatory Clinical Pharmacist - Board of Pharmacy SpecialistBoard of Pharmacy SpecialistBoard of Pharmacy Specialist, Licensed Attorney - Massachusetts Bar AssociationMassachusetts Bar AssociationMassachusetts Bar Association, Licensed Clinical Social Worker - OtherOtherOther, Registered Nurse - State of MassachusettsState of MassachusettsState of Massachusetts

Compensation

Note: The compensation range(s) in the table below represent the base salaries for all positions at a given grade across the health system. Typically, a new hire can expect a starting salary somewhere in the lower part of the range. Actual salaries may vary by position and will be determined based on the candidate's relevant experience. No employee will be paid below the minimum of the range. Pay ranges are listed as hourly for non-exempt employees and based on assumed full time commitment for exempt employees.

Minimum - Midpoint - Maximum

$174,283.00 - $200,324.00 - $236,891.00

Equal Employment Opportunity Employer

Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.

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