Curana Health is a provider of value-based primary care services for the senior living industry, including skilled nursing facilities, assisted & independent living communities, Memory Care units, and affordable senior housing sites. Our 1,000+ clinicians serve more than 1,500 senior living community partners across 34 states, and Curana participates in various innovative CMS programs (including owned-and-operated Accountable Care Organizations and Medicare Advantage plans). With rapid year-over-year growth since our founding in 2021, Curana is setting a new standard in innovative care delivery for seniors with high-risk, complex clinical needs, many of whom have been historically underserved by the healthcare system. Our mission: To radically improve the health, happiness and dignity of senior living residents.

The Risk Adjustment Documentation Specialist is responsible for reviewing medical records rooted in compliance by adhering to CMS’ coding and reporting guidelines and accurately coding diagnoses for risk adjustment purposes.  In addition, the Risk Adjustment Documentation Specialist will assist with chart procurement, provider education, and training.  The ideal candidate will leverage their coding expertise to support audits, validate claims, and enhance the accuracy and integrity of risk adjustment submissions to CMS.

• Medical Record Review: Analyze medical records to ensure accurate coding of diagnoses in compliance with ICD-10-CM and risk adjustment guidelines.
• Chart Procurement: Obtain medical records in a readable format from various EHR systems within our network in support of both internal and external audits and annual chart review campaigns.
• Data Validation: Validate submitted diagnosis codes against documentation in patient medical records for CMS-HCC, HHS-HCC, and other applicable models.
• Compliance Assurance: Maintain adherence to CMS’ official guidelines for coding and reporting and organizational policies.
• Collaboration: Work closely with physicians, auditors, and other team members to resolve coding discrepancies and ensure accurate risk adjustment data submissions.
• Quality Audits: Participate in internal and external quality assurance audits, providing feedback and implementing corrective actions as necessary.
• Education & Training: Assist in educating providers and staff on documentation improvements and risk adjustment best practices.
• Reporting: Prepare and submit detailed reports on coding findings, trends, and recommendations to leadership.

Education & Certifications:

• High school diploma or equivalent (required); Associate’s or Bachelor’s degree in Health Information Management or related field (preferred).
• Active certification as a Certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC), or Certified Coding Specialist (CCS).

Experience:

• Minimum 2-3 years of experience in medical coding with a focus on risk adjustment and RADV audits.
• Proficient understanding of CMS and HHS risk adjustment models.
• Familiarity with EHR systems and medical record documentation standards.

Skills:

• Strong knowledge of ICD-10-CM coding guidelines.
• Exceptional attention to detail and analytical skills.
• Excellent written and verbal communication skills.
• Ability to work independently and manage time effectively.
• Proficiency in Microsoft Office Suite and coding software (e.g., 3M, Optum).

Preferred Qualifications

• Experience in RADV audits for Medicare Advantage plans.
• Knowledge of healthcare compliance regulations and HIPAA.
• Prior experience working in a payer or provider environment.

Curana Health is dedicated to the principles of Equal Employment Opportunity. We affirm, in policy and practice, our commitment to diversity. We do not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable or state law, genetic information, or any other characteristic protected by applicable federal, state and local laws and ordinances.

The EEO policy applies to all personnel matters as outlined in our company policy including recruitment, hiring, transfers, and general treatment during employment.

*The company is unable to provide sponsorship for a visa at this time (H1B or otherwise).