Risk Adjustment Coordinator/ HCC Coding Specialist

We are seeking a detail-oriented and analytical HEDIS & MRA Patient Coordinator to support our client's Primary Care practice across three locations in Florida. The ideal candidate has deep hands-on experience in a U.S. Primary Care setting, managing HEDIS quality gap workflows, applying Medicare Risk Adjustment (HCC/ICD-10) coding logic, and conducting proactive outbound patient scheduling to ensure comprehensive clinical care and payer compliance.

Key Responsibilities:

Gap Report Reconciliation: Pull, read, and cross-reference payer gap/quality reports from portals (e.g., Availity, Humana, Florida Blue) against EMR patient charts.

Proactive Patient Outreach: Conduct outbound phone calls to schedule overdue preventive care visits, including annual wellness exams, mammograms, Pap smears, and colorectal cancer screenings.

EMR Chart Alerts: Enter clinical alerts, reminders, and messages directly into patient charts so providers order the correct diagnostic tests and document active conditions at the point of care.

MRA & HCC Recapture: Apply HEDIS measure logic and ICD-10 linking knowledge to track chronic condition recaptures, accurately link complications, and close care gaps annually.

Compliance Tracking: Monitor clinic-wide progress to ensure ongoing compliance with Medicare Advantage and value-based care quality benchmarks.

Requirements

• Primary Care Experience: Minimum 2+ years of experience working directly in a U.S. Primary Care or Family Medicine practice.
• Technical Knowledge: Strong working knowledge of HEDIS measures, Medicare Risk Adjustment (MRA), Hierarchical Condition Category (HCC) coding, and ICD-10 diagnosis linking.
• Communication: Clear, professional, and articulate spoken and written English.
• Outbound Outreach: Comfortable and confident making outbound patient calls to encourage and schedule preventive care appointments.
• Software Proficiency: Familiarity with Electronic Health Records (eClinicalWorks/eCW or eMedicalPractice preferred) and VOIP platforms (RingCentral preferred).

Please note that this is a full-time contractor position (40 hours per week) with a starting pay rate of $6 per hour depending on skill set and experience. The schedule is Monday through Friday, 8:30 AM - 5PM EST.