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Vice President Hcc Risk Adjustment Coder Jobs in Michigan

Lake Trust Credit Union

VP, Lending

Brighton, MI · On-site

Vice President, Lending More Than A Job! Why do you work each day? To us, our jobs are not just ... Manage strategic risk and monitor lending KPIs, profitability, portfolio health, risk trends, and ...

Ohio Health

Summary: Job Code: 0095 Job Profile Name: VP, Controller JOB SUMMARY The VP, Controller of ... risk, and control matters Partner with executives across the enterprise to strengthen end-to-end ...

Vibe Credit Union

VP of Risk

Novi, MI

Job Title: VP of Risk Reports To: Chief Financial Officer Department: ERM Grade: 16 Location: Novi / Ops Date Revised: 5.6.2026 Our Purpose: At Vibe, we are driven by our mission to elevate community ...

Sun, Inc.

VP, Strategy and M&A

Southfield, MI

Overview The Vice President, Strategy and M&A is responsible for leading new acquisition ... Conducts annual team member performance review evaluations and recommends compensation adjustments ...

Sun RV Resorts

VP, Strategy and M&A

Southfield, MI

Overview The Vice President, Strategy and M&A is responsible for leading new acquisition ... Conducts annual team member performance review evaluations and recommends compensation adjustments ...

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Vice President Hcc Risk Adjustment Coder information

What is the difference between Vice President Hcc Risk Adjustment Coder vs Hcc Risk Adjustment Coder?

AspectVice President Hcc Risk Adjustment CoderHcc Risk Adjustment Coder
CredentialsAdvanced certifications, leadership experienceCertifications like CPC, CCS, or RHIT
Work EnvironmentExecutive-level, strategic planningOperational, coding departments
Industry UsageUsed in large healthcare organizations, insurersCommon in hospitals, clinics, coding firms

The Vice President Hcc Risk Adjustment Coder focuses on strategic leadership and oversight of risk adjustment coding programs, often requiring advanced certifications and leadership skills. In contrast, the Hcc Risk Adjustment Coder handles day-to-day coding tasks, ensuring accurate HCC coding based on medical records. Both roles are vital in healthcare risk management but differ mainly in scope, responsibilities, and experience level.

What are some common challenges faced by a Vice President HCC Risk Adjustment Coder, and how can they be managed?

A Vice President HCC Risk Adjustment Coder often faces the challenge of ensuring coding accuracy and compliance across large teams while keeping up with evolving CMS guidelines. Managing remote or distributed coding staff, integrating new technology solutions, and balancing productivity with quality assurance are also common hurdles. Success in this role requires strong communication skills, ongoing coder education, and the implementation of robust audit processes to maintain data integrity and regulatory compliance.

What are Vice President HCC Risk Adjustment Coders?

A Vice President HCC (Hierarchical Condition Category) Risk Adjustment Coder is a senior executive responsible for overseeing the medical coding operations related to risk adjustment in healthcare organizations. They lead teams that ensure accurate coding of patient diagnoses and health information, which impacts how healthcare providers are reimbursed by insurance payers, especially Medicare Advantage plans. Their role typically involves compliance oversight, quality assurance, training coders, and strategic planning to optimize risk scores. These professionals require extensive experience in medical coding, deep knowledge of HCC models, and strong leadership skills. They play a critical part in helping organizations maximize compliant reimbursement and improve patient outcomes.

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

To thrive as a Vice President HCC Risk Adjustment Coder, you need deep expertise in HCC coding, risk adjustment methodologies, healthcare regulations, and a relevant certification such as CPC, CRC, or CCS. Mastery of coding software, EHR systems, and data analytics platforms is typically required. Leadership, strategic thinking, attention to detail, and strong communication skills distinguish top performers in this role. These skills are crucial for ensuring coding accuracy, regulatory compliance, and driving organizational success in value-based care environments.
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Risk Adjustment Compliance Coder

Risk Adjustment Compliance Coder

Upper Peninsula Health Plan

Marquette, MI • Remote

$28.86/hr

Full-time

Posted 5 days ago

Job description

DATE: July 20, 2026POSITION:  Risk Adjustment Compliance CoderDEPARTMENT:  Finance-Risk AdjustmentRATE: $28.86 per hour, with potential for additional compensation based on qualifications. POSITION SUMMARY: 
The Risk Adjustment Compliance Coder is responsible for enhancing the accuracy, quality, and integrity of coding data that supports Medicare and Medicaid reimbursement. This role conducts risk adjustment coding audits, performs compliance research, responds to coding inquiries, and serves as a subject matter expert in risk adjustment coding and compliance. The position supports Medicare and Medicaid risk adjustment programs through the development, implementation, and ongoing evaluation of program initiatives. Highly collaborative and operational in nature, this role partners closely with providers and internal stakeholders and requires strong communication, education, and relationship-management skills. This is not a traditional production-focused coding position. 
ESSENTIAL DUTIES AND RESPONSIBILITIES:
1. Follows established Upper Peninsula Health Plan (UPHP) policies and procedures, objectives, safety standards, and sensitivity to confidential information.
 
2. Collaborates with Risk Adjustment Analyst to develop, implement, and continually refine internal prospective and retrospective chart review programs and related risk adjustment initiatives.
 
3. Follows International Classification of Diseases (ICD)-10 guidelines for Coding and Reporting, Centers for Medicare & Medicaid Services (CMS) risk adjustment guidelines, and demonstrates knowledge of Current Procedural Terminology (CPT) coding. Understands the impact of ICD-10 coding on the CMS Hierarchical Condition Categories (HCC) risk adjustment model, and serves as the subject matter expert for risk adjustment activities.
 
4. Supports risk adjustment compliance and program integrity activities, including RADV preparedness, high-risk diagnosis review and validation, audit support, and identification and escalation of potential coding or documentation compliance concerns.
 
5. Assists with extraction of charts via remote Electronic Medical Record (EMR) access or faxed medical record request for risk adjustment initiatives.
 
6. Performs comprehensive medical record review, verifying and ensuring accuracy, completeness, specificity, and appropriateness of diagnoses codes in accordance with ICD-10 guidelines based on medical record documentation. Documents trends, observations, and potential coding or documentation improvement opportunities identified during the review process.
 
7. Maintains a comprehensive tracking and management tool to track all coding activities; generates and maintains accurate weekly, monthly, and quarterly reports of activities.
 
8. Assists with chart review encounter data submissions to CMS based on chart review findings.
 
9. Provides support during the annual retrospective chart review performed by an external party.
 
10. Identifies, develops, and delivers general and specific educational guidance to providers and clinic staff through webinars, newsletters, presentations, and other educational forums based on risk adjustment audit findings, CMS guidelines, regulatory requirements, and industry best practices.
 
11. Collaborates with internal departments, as appropriate, to carry out risk adjustment program activities to ensure integrity of diagnoses attributed to members submitted to the Michigan Department of Health and Human Services (MDHHS) and CMS by UPHP.
 
12. Collaborates with healthcare leaders, physicians, and provider office personnel to improve the accuracy and completeness of diagnosis code capture. Facilitates provider education, documentation clarification, and coding-related discussions in a professional, consultative manner to support risk adjustment and compliance objectives. 
 
13. Maintains confidentiality of client data.
 
14. Performs other related duties as assigned or requested.
POSITION QUALIFICATIONS:Education:Minimum:
High School Diploma
 Preferred:
Associate degree in business, health information processing, or related field 
 Certification:Minimum:
Must possess and maintain an American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) certification—Certified Coding Specialist (CCS), Certified Coding Specialist-Physician (CCS-P), Certified Professional Coder (CPC), or Certified Risk Adjustment Coder (CRC)
 Preferred:
Certified Coding Specialist (CCS-P, CCS, CPC) and Certified Risk Adjustment Coder (CRC)
 
Experience:Minimum:
Two (2) years of experience in medical chart coding
 Preferred:
Five (5) years of experience in medical chart coding, including inpatient and outpatient settings; working knowledge of managed care and health plan standards on Risk Adjustment Coding
 
Other Qualifications:
Knowledge and understanding of medical terminology, disease process, and anatomy and physiology
Advanced knowledge and understanding of CPT coding across a wide variety of provider specialties
 Required Skills:
Excellent organizational abilities with attention to detail
Ability to effectively communicate with, and educate, clinic staff (provider, care managers, clinic quality leads, etc.)
Working knowledge of Microsoft Office (Word, Excel, Outlook)
Keyboarding proficiency
Research and analytical skills
 Preferred Skills:
Knowledge of MS PowerPoint
Oriented to managed care
 
The qualifications listed above are intended to represent the minimum skills and experience levels associated with performing the duties and responsibilities contained in this job description. The qualifications should not be viewed as expressing absolute employment or promotional standards, but as general guidelines that should be considered along with other job-related selection or promotional criteria.
 
Physical Requirements: 
[This job requires the ability to perform the essential functions contained in the description. These include, but are not limited to, the following requirements. Reasonable accommodations may be made for otherwise qualified applicants unable to fulfill one or more of these requirements]:
 
Ability to enter and access information from a computer
Occasionally lifts supplies/equipment
Prolonged periods of sitting
Manual dexterity 
 
Working Conditions:
Position available onsite (in Marquette, Michigan), fully remote, or hybrid with a remote work option up to three (3) days per week 
Works in office conditions, but occasional travel is required
Exposure to situations requiring exceptional interpersonal skills or high productivity
Occasionally subjected to irregular hours
Subject to many interruptions
 Remote Work Requirements:
Remote candidates must reside in the state of Michigan
For fully remote team members, initial on-site/in-person onboarding and training for a minimum of ten (10) consecutive business days at UPHP’s headquarters in Marquette, Michigan (stipend provided) 
Periodic travel to UPHP’s headquarters for regular training including all staff meetings
Private home office required; computer and phone hardware provided
Personal vehicle required for periodic travel; mileage reimbursement provided at GSA rate
Employment Type: FULL_TIME

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