Summary:
The Medicare Risk Adjustment (MRA) Coder plays a critical role in driving risk adjustment accuracy and provider documentation quality across the Genuine Health Group network. Fluency in English and Spanish is required for this role, as the ideal candidate will support both retrospective and concurrent chart reviews, leveraging strong knowledge of Hierarchical Condition Categories (HCC) and MEAT (Monitoring, Evaluation, Assessment, Treatment) documentation standards to ensure complete, accurate, and compliant capture of chronic conditions. The ideal candidate will be analytical, adaptable, and highly skilled in translating medical documentation into actionable coding insights, while also serving as an educational partner to providers.
Essential Duties and Responsibilities:
- Review and audit patient medical records— including histories and physicals, progress notes, diagnostic reports, pathology results, medication, labs results and discharge summaries— to ensure diagnoses are accurately captured, documented, and coded in compliance with CMS risk adjustment standards.
- Apply MEAT criteria to validate chronic conditions and ensure accurate HCC capture.
- Conduct comprehensive retrospective chart reviews for each assigned panel twice per year - every semester.
- Perform pre and post-visit chart audits to support real-time documentation improvement proactively identify coding opportunities.
- Submit validated HCC codes accurately and in a timely manner through appropriate platforms.
- Lead chart review discussions with providers and clinical teams, offering data-driven insights to enhance documentation.
- Foster collaborative relationships with provider offices to support engagement and education.
- Identify trends in under coding or documentation gaps and escalate key findings when necessary.
- Coordinate retrieval of medical records from internal and external sources to support chart reviews and audit requests.
- Ensure compliance with CMS guidelines and applicable regulations on coding.
- Educate physicians and staff on documentation specificity and coding best practices.
- Maintain audit logs and generate performance reports.
- Collaborate with Quality team on HEDIS and care gap initiatives.
- Travel locally approximately 30% of the workweek to support on-site provider engagement. (70% remote / 30% on-site hybrid model - may vary based on EMR system per provider)
- Participate in special projects or duties as assigned.
- Out-of-state travel, if necessary, includes requirements for some ACOs offices, with all expenses covered by the company.
Qualifications & Skills
- Deep knowledge of ICD-10, HCC coding, MEAT criteria, and CMS risk adjustment methodologies.
- Strong understanding of Medicare Advantage, value-based care, and electronic medical record (EMR) systems.
- Proficient in Microsoft Excel, Outlook, and web-based chart review platforms.
- Excellent communication skills in both Spanish and English (written and verbal).
- High attention to detail with strong organizational and critical thinking abilities.
- Self-motivated and able to work independently in a field-based setting.
- Proven ability to engage and educate providers and any other staff on documentation improvement.
Minimum Education and Experience
- Certification required: CPC, CRC, CPMA, CCS-P, CCS, RHIA, or RHIT.
- 3+ years of MRA coding experience with Medicare Advantage populations.
- 1+ year of fee-for-service billing experience preferred.
- Bachelor’s degree preferred; FMG or international medical graduate background a plus.
- Bilingual fluency in Spanish and English is required.
Genuine Health Group offers a competitive compensation and benefits package that includes a 401k matching program, fully subsidized medical plans, paid holidays and much more. Base salary will be commensurate to professional experience. All final employment offers are contingent upon successful completion of background checks.
Genuine Health Group is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Job Type: Full-time
Pay: From $65,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Employee discount
- Flexible schedule
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Application Question(s):
- Do you now or will you in the future require sponsorship to work in the United States?
- What are your salary expectations for the role?
Experience:
- Medicare Risk Adjustment Coding: 3 years (Required)
- ICD-10 Coding: 1 year (Preferred)
- CPT Coding: 1 year (Preferred)
Language:
- English and Spanish (Required)
License/Certification:
- CPC /CPMA/ CRC/ CCS-P/ CCS/ RHIA or RHIT certification (Required)
Ability to Commute:
- Coral Gables, FL 33134 (Required)
Willingness to travel:
Work Location: Hybrid remote in Coral Gables, FL 33134
