Risk Adjustment Coding Specialist
Gather Health Gather Health Primary Care, Inc., Boston, MA, United States
Description
Who is Gather Health?
We are a new and growing healthcare organization with a unique and innovative approach to healthcare. Our mission is to improve lives and communities through socially supported primary care for older adults. Our innovative business model allows our clinicians to treat the whole patient - not just their clinical needs. We do this by having a dedicated care team that supports our clinicians by addressing our patients’ social determinants of health and providing the highest quality of service possible. Our ultimate vision is creating generational health and equity for communities across the country, one patient at a time.
The Risk Adjustment Coding Specialist
will play a pivotal role in supporting accurate and complete diagnosis documentation as part of Gather Health’s commitment to value-based care under Medicare Advantage and ACO REACH contracts. Embedded within a collaborative, interdisciplinary team—including primary care providers, clinical support staff, and care coordination specialists—this role ensures that coding practices align with clinical realities, driving both quality outcomes and appropriate reimbursement.
With deep expertise in the CMS-HCC Risk Adjustment Payment Model (V28), Hierarchical Condition Category (HCC) and CPT coding, the Specialist will serve as a trusted partner to providers, offering 1:1 feedback, leading group education sessions, and identifying opportunities for documentation improvement. Through both remote and in-person collaboration, this role strengthens the connection between frontline care delivery and compliant, effective coding practices.
Duties & Responsibilities
Making sure that codes are assigned correctly and sequenced appropriately as per government and insurance regulations
Complying with medical coding guidelines and policies
Reviewing patients’ charts and documents for verification and accuracy (retrospective, prospective and Concurrent Chart Review)
Ensuring that all documented risk adjusted conditions or HCCs are compliantly supported via the MEAT criteria
Maintaining productivity and quality standards as set by the company
Communicating professionally with co-workers regarding clinical and reimbursement issues
Reporting missing or incomplete documentation while working with the providers to fix documentation errors.
Following up and clarifying any information that is not clear to PCPs.
Minimum Requirements
Two (2) + years previous experience as a certified professional coder
One year of risk adjustment experience
Certified Risk Adjustment Coding certificate (CRC) preferred
Certified Professional Coder through the American Academy of Professional Coders (AAPC) or Certified Coding Specialist through the American Health Information Management Academy (AHIMA)
Proficient computer skills, Microsoft Office Suite (Word, PowerPoint, Outlook, and Excel)
Must live in the surrounding Boston area and willing to visit our four (4) centers regularly
Preferred Skills
AS degree in accounting, health care administration, finance, business, or related field preferred
Able to multitask, prioritize, and manage time efficiently
Self-motivated and self-directed; able to work without supervision
Excellent verbal, written, and interpersonal communication skills
Gather Health delivers Social Primary Care to older adults. Through our unique and differentiated care model and proprietary technology, Gather Health’s solution drives substantial care outcomes by addressing the whole person needs of our target demographic: older, dual eligible adults, the fastest growing government segment. To address the needs of these clinically and socially complex patients, Gather Health’s Social Primary Care solution is comprehensive and wholistic in nature, encompassing care and community within the four walls of Gather Health Centers and in the homes of its patients.
Gather’s model achieves superior care by individualizing care and is reinforced by a three-prong approach: a unique care model quarterbacked by PCPs and supported by multi-disciplinary care teams, tailored Social Care Plans that are led by Gather Guides and facilitated by deeply rooted community partners, and a proprietary “Tech Enabled Home Model.”
Founded in 2022 and born out of the Healthcare Foundry Portfolio, Gather Health is addressing a $1 trillion market in primary care for older adults. Today, Gather Health operates in Massachusetts and is working with a multitude of payer partners on aligning value-based care economics to deliver integrated care. Gather’s leadership team has a track record of building and scaling innovative primary care platforms focused on vulnerable populations, including VillageMD and Commonwealth Care Alliance. Gather has raised $30M backed by Maverick Ventures, Khosla, and HC9 Ventures.
Benefits
Health:
Comprehensive medical, dental, and vision with day-one eligibility
Protection:
Company-paid Life, Short-Term, and Long-Term Disability insurance
Retirement:
401(k) with company match and immediate vesting
Time Off:
Generous PTO that increases with tenure and 11 paid company holidays
Wellness:
Employee Assistance Program (EAP) and supplemental benefit options
Gather Health is an Equal Opportunity Employer. All employment decisions are made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.
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We are a new and growing healthcare organization with a unique and innovative approach to healthcare. Our mission is to improve lives and communities through socially supported primary care for older adults. Our innovative business model allows our clinicians to treat the whole patient - not just their clinical needs. We do this by having a dedicated care team that supports our clinicians by addressing our patients’ social determinants of health and providing the highest quality of service possible. Our ultimate vision is creating generational health and equity for communities across the country, one patient at a time.
The Risk Adjustment Coding Specialist
will play a pivotal role in supporting accurate and complete diagnosis documentation as part of Gather Health’s commitment to value-based care under Medicare Advantage and ACO REACH contracts. Embedded within a collaborative, interdisciplinary team—including primary care providers, clinical support staff, and care coordination specialists—this role ensures that coding practices align with clinical realities, driving both quality outcomes and appropriate reimbursement.
With deep expertise in the CMS-HCC Risk Adjustment Payment Model (V28), Hierarchical Condition Category (HCC) and CPT coding, the Specialist will serve as a trusted partner to providers, offering 1:1 feedback, leading group education sessions, and identifying opportunities for documentation improvement. Through both remote and in-person collaboration, this role strengthens the connection between frontline care delivery and compliant, effective coding practices.
Duties & Responsibilities
Making sure that codes are assigned correctly and sequenced appropriately as per government and insurance regulations
Complying with medical coding guidelines and policies
Reviewing patients’ charts and documents for verification and accuracy (retrospective, prospective and Concurrent Chart Review)
Ensuring that all documented risk adjusted conditions or HCCs are compliantly supported via the MEAT criteria
Maintaining productivity and quality standards as set by the company
Communicating professionally with co-workers regarding clinical and reimbursement issues
Reporting missing or incomplete documentation while working with the providers to fix documentation errors.
Following up and clarifying any information that is not clear to PCPs.
Minimum Requirements
Two (2) + years previous experience as a certified professional coder
One year of risk adjustment experience
Certified Risk Adjustment Coding certificate (CRC) preferred
Certified Professional Coder through the American Academy of Professional Coders (AAPC) or Certified Coding Specialist through the American Health Information Management Academy (AHIMA)
Proficient computer skills, Microsoft Office Suite (Word, PowerPoint, Outlook, and Excel)
Must live in the surrounding Boston area and willing to visit our four (4) centers regularly
Preferred Skills
AS degree in accounting, health care administration, finance, business, or related field preferred
Able to multitask, prioritize, and manage time efficiently
Self-motivated and self-directed; able to work without supervision
Excellent verbal, written, and interpersonal communication skills
Gather Health delivers Social Primary Care to older adults. Through our unique and differentiated care model and proprietary technology, Gather Health’s solution drives substantial care outcomes by addressing the whole person needs of our target demographic: older, dual eligible adults, the fastest growing government segment. To address the needs of these clinically and socially complex patients, Gather Health’s Social Primary Care solution is comprehensive and wholistic in nature, encompassing care and community within the four walls of Gather Health Centers and in the homes of its patients.
Gather’s model achieves superior care by individualizing care and is reinforced by a three-prong approach: a unique care model quarterbacked by PCPs and supported by multi-disciplinary care teams, tailored Social Care Plans that are led by Gather Guides and facilitated by deeply rooted community partners, and a proprietary “Tech Enabled Home Model.”
Founded in 2022 and born out of the Healthcare Foundry Portfolio, Gather Health is addressing a $1 trillion market in primary care for older adults. Today, Gather Health operates in Massachusetts and is working with a multitude of payer partners on aligning value-based care economics to deliver integrated care. Gather’s leadership team has a track record of building and scaling innovative primary care platforms focused on vulnerable populations, including VillageMD and Commonwealth Care Alliance. Gather has raised $30M backed by Maverick Ventures, Khosla, and HC9 Ventures.
Benefits
Health:
Comprehensive medical, dental, and vision with day-one eligibility
Protection:
Company-paid Life, Short-Term, and Long-Term Disability insurance
Retirement:
401(k) with company match and immediate vesting
Time Off:
Generous PTO that increases with tenure and 11 paid company holidays
Wellness:
Employee Assistance Program (EAP) and supplemental benefit options
Gather Health is an Equal Opportunity Employer. All employment decisions are made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.
#J-18808-Ljbffr