Registered Nurse - HCC/RAF Coding Specialist
Sign up free to see how well your resume matches this role.
What you'll do
- Review medical records and assign accurate ICD-10-CM diagnosis codes in accordance with CMS HCC guidelines.
- Identify documentation gaps and collaborate with providers to clarify incomplete, conflicting, or ambiguous documentation.
- Maintain accurate patient problem lists by adding, updating, and resolving diagnoses as appropriate.
- Identify and validate chronic conditions that impact Medicare Risk Adjustment (RAF) and quality reporting initiatives.
- Educate providers and clinical staff on HCC coding, documentation improvement strategies, and coding best practices.
- Utilize risk adjustment analytics and reports to prioritize chart reviews, provider education, and documentation improvement efforts.
- Support Medicare Annual Wellness Visits, Population Health initiatives, clinical outcome programs, and quality improvement activities.
- Serve as a clinical coding resource while promoting compliance with CMS regulations, ICD-10-CM coding standards, and organizational policies.
What they're looking for
- Associate Degree in Nursing (ADN) required.
- Current Massachusetts Registered Nurse (RN) license required.
- Minimum of three (3) years of clinical RN experience required.
- Valid driver's license required.
- Experience with electronic medical record systems.
- Strong clinical knowledge of chronic disease management.
- Knowledge of ICD-10-CM coding, CMS HCC guidelines, Medicare Risk Adjustment methodologies, HEDIS, and Clinical Documentation Improvement (CDI) principles.
- Excellent communication, organizational, analytical, and problem-solving skills.
- Proficiency with Microsoft Office applications and electronic medical record systems.
- Ability to work independently while managing multiple priorities and maintaining high productivity, accuracy, and quality standards.
Nice to have
- Bachelor of Science in Nursing (BSN) preferred.
- Physician practice clinical experience.
- Experience with HCC/RAF coding, Medicare Risk Adjustment, Clinical Documentation Improvement (CDI), or Population Health initiatives.
- Cerner experience preferred.
- Strong presentation, facilitation, provider education, and relationship-building skills.
- Self-motivated with a commitment to continuous learning and maintaining current knowledge of CMS HCC, ICD-10-CM, Medicare Risk Adjustment, and related regulatory guidelines.
Summarised by NextRaise from the employer’s description, which follows in full below.
Full description from employer
Registered Nurse - HCC/RAF Coding Specialist
Registered Nurse in Springfield, MA | Baystate Health Careers
Department: Population Health
Location: Baystate Health, Springfield, Massachusetts
Job Type: Full-Time
Shift: Days
Make an Impact with Baystate Health
Baystate Health is seeking a Registered Nurse - HCC/RAF Coding Specialist to join our Population Health team in Springfield, Massachusetts. This role supports Baystate Health's Value-Based Care and Population Health initiatives by conducting comprehensive medical record reviews, identifying risk-adjustment opportunities, and ensuring accurate and compliant clinical documentation for Medicare populations.
The Registered Nurse - HCC/RAF Coding Specialist role offers the opportunity to combine clinical expertise with coding, quality, and population health initiatives while partnering closely with providers and practice staff across the Baystate Health system. This position plays a critical role in improving documentation quality, supporting Medicare Risk Adjustment (RAF) accuracy, enhancing patient outcomes, and advancing organizational quality and reimbursement goals.
The Registered Nurse Will:
- Review medical records and assign accurate ICD-10-CM diagnosis codes in accordance with CMS HCC guidelines.
- Identify documentation gaps and collaborate with providers to clarify incomplete, conflicting, or ambiguous documentation.
- Maintain accurate patient problem lists by adding, updating, and resolving diagnoses as appropriate.
- Identify and validate chronic conditions that impact Medicare Risk Adjustment (RAF) and quality reporting initiatives.
- Educate providers and clinical staff on HCC coding, documentation improvement strategies, and coding best practices.
- Utilize risk adjustment analytics and reports to prioritize chart reviews, provider education, and documentation improvement efforts.
- Support Medicare Annual Wellness Visits, Population Health initiatives, clinical outcome programs, and quality improvement activities.
- Serve as a clinical coding resource while promoting compliance with CMS regulations, ICD-10-CM coding standards, and organizational policies.
Schedule Details
- Job Type: Full-Time
- Shift: Days
- Hours: 40 hours per week
- Schedule: Monday-Friday
- Weekend Requirement: None
- On-Call Requirement: None
- Other Scheduling Requirements: Hybrid work schedule with the ability to travel to practices throughout the Baystate Health System to conduct provider education, training sessions, and on-site documentation improvement initiatives.
Benefits That Support You
At Baystate Health, you get the best of both worlds: the resources, stability, and career opportunities of a large integrated healthcare system with the supportive culture of a community-focused organization.
Depending on eligibility, benefits may include:
- Competitive Pay & Benefits: Excellent compensation with high-quality, low-cost medical, dental, and vision coverage.
- Tuition & Training: Certification and continuing education reimbursement.
- Career Growth: Opportunities to expand expertise in Population Health, Clinical Documentation Improvement, Risk Adjustment, and Value-Based Care initiatives.
- Regional Opportunities: Career opportunities across Baystate Health hospitals, medical practices, and services throughout western Massachusetts.
- Retirement: 403(b) retirement plan with company match and annual company contribution increases based on years of service.
- Paid Time Off: Generous PTO for eligible employees.
- Additional Benefits: Life insurance, pet, home, auto, and personal insurance; free financial coaching; reimbursement for wellbeing activities including gym memberships, fitness equipment, personal training, massage therapy, and more; and comprehensive wellbeing programs supporting mental, physical, and financial health.
About Baystate Health
Baystate Health is an integrated healthcare system serving patients and communities throughout western Massachusetts. Our network includes Baystate Medical Center, Baystate Children's Hospital, Baystate Noble Hospital, Baystate Franklin Medical Center, Baystate Wing Hospital, Baystate Medical Practices, and Baystate Home Health & Hospice.
Whether you provide direct patient care, clinical services, or operational support, your work at Baystate Health helps improve the health of the communities we serve.
Required Skills
- Associate Degree in Nursing (ADN) required.
- Current Massachusetts Registered Nurse (RN) license required.
- Minimum of three (3) years of clinical RN experience required.
- Valid driver's license required.
- Experience with electronic medical record systems.
- Strong clinical knowledge of chronic disease management.
- Knowledge of ICD-10-CM coding, CMS HCC guidelines, Medicare Risk Adjustment methodologies, HEDIS, and Clinical Documentation Improvement (CDI) principles.
- Excellent communication, organizational, analytical, and problem-solving skills.
- Proficiency with Microsoft Office applications and electronic medical record systems.
- Ability to work independently while managing multiple priorities and maintaining high productivity, accuracy, and quality standards.
Preferred Qualifications & Skills
- Bachelor of Science in Nursing (BSN) preferred.
- Physician practice clinical experience.
- Experience with HCC/RAF coding, Medicare Risk Adjustment, Clinical Documentation Improvement (CDI), or Population Health initiatives.
- Cerner experience preferred.
- Strong presentation, facilitation, provider education, and relationship-building skills.
- Self-motivated with a commitment to continuous learning and maintaining current knowledge of CMS HCC, ICD-10-CM, Medicare Risk Adjustment, and related regulatory guidelines.
Start Your Career at Baystate Health
You Belong at Baystate.
Education:
Associates Degree (Required)Certifications:
Driver License - OtherOtherOther, Registered Nurse - State of MassachusettsState of MassachusettsState of MassachusettsCompensation
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
$89,606.00 - $103,001.00 - $121,804.00
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.
Company
Company facts come from this company's own listings. We only show what the postings themselves carry.