Risk Adjustment Clinical Coder

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Central Maine Healthcare
November 16, 2020
Lewiston, Maine
Job Type


Risk Adjustment Clinical Coder


Full Time-Non Exempt

Req #: 27196

JOB SUMMARY: The Coder will be responsible for reviewing Central Maine ACO providers' medical record documentation to ensure use of accurate medical coding of all professional, inpatient and outpatient services, procedures, diagnoses and conditions in support of compelte and accurate risk adjustment revenue for applicable ACO populations. The coder will review provider documentation of ICD-9-CM/ICD-10-CM codes to verify that coding meets both established coding standards as well as CMS Risk Adjustment guidelines. The coder will lead efforts to evaluate the HCC coding practices and provide analyses and recommendations to improve overall provider documentation and coding. The Risk Adjustment Coding Auditor will review medical records to determine if diagnostic codes (ICD-9-CM/ICD-10-CM) are accurately reflecting the provider documentation. The coder will summarize findings for internal and external parties.


  • Accurately and efficiently reviews medical charts and assigns the correct diagnosis (ICD-9/10 CM), procedure (CPT), and supply (HCPCS Level II) code for a wide variety of clinical cases and services.
  • Identify, collect, assess, monitor and document claims and encounter coding information as it pertains to Clinical Condition Categories.
  • Verify and ensure the accuracy, completeness, specificity and appropriateness of diagnosis codes based on services rendered.
  • Review medical record information to identify all appropriate coding based on CMS HCC categories.
  • Effectively communicates with physicians in order to clarify diagnoses/procedures and sequencing of diagnoses.
  • Utilizes specialized coding knowledge and auditing skills to achieve established coding quantity and quality standards.
  • Assesses medical coding practices and suggests areas of improvement for follow up physician training and communication.
  • Performs other duties as assigned.

Regulatory Requirements:

  • Bachelors Degree or combination of relevant education and experience
  • Certified Professional Coder (CPC) or Certified Coding Specialist (CCS); Certified Risk Adjustment Coder (CRC) preferred
  • 2+ years of billing/coding experience in a medical/surgical or facility setting
  • Knowledge of diagnoses/procedures in accordance with ICD-9/10-CM coding principles for HCC coding
  • Experience with CMS Medicare Advantage Risk Adjustment preferred
  • Ability to work with physicians and care team staff in a collaborative manner

Language Skills:

  • Ability to read and communicate effectively in English.
  • Excellent written and verbal communication skills required


  • Basic computer knowledge - Proficiency with Microsoft office products, specifically Excel, Word and Access
  • Strong problem solving skills
  • Strong organizational skills
  • Exceptional Customer Service skills
  • Ability to work independently with minimal supervision
  • Ability to exercise independent discretion and judgment to make coding decisions


Travel Requirements:

  • Travel to ACO provider physical locations may be required.



Our mission is to provide exceptional healthcare services in a safe and trustful environment through expertise, commitment and compassion of our team members, with the vision of safe, reliable, high quality care for each patient, every day.

How do we make this happen? By creating and maintaining a culture where our values of compassion, integrity, citizenship, service excellence and community are lived out in observable behaviors during all interactions.


Central Maine Healthcare (CMH) is an integrated healthcare delivery system serving 400,000 people living in central, western, and mid-coast Maine. CMH's hospital facilities include Central Maine Medical Center in Lewiston, Bridgton Hospital, and Rumford Hospital. CMH also supports Central Maine Medical Group, a primary and specialty care practice organization. Other system services include the Central Maine Heart and Vascular Institute, a regional trauma program, LifeFlight of Maine's southern Maine base, the Central Maine Comprehensive Cancer Center, and other high quality clinical services.

About Central Maine Medical Center

Central Maine Medical Center (CMMC) located in Lewiston, is a Level II Trauma Center serving Androscoggin County and the surrounding region. "CMMC's Centers of Excellence" include the Central Maine Heart and Vascular Institute, the Central Maine Comprehensive Cancer Center, the Neonatal Intermediate Care Unit, and a Trauma Services Program. CMMC is also the southern Maine base for LifeFlight of Maine, the state's only medical helicopter service. Supported by the latest technologies, CMMC's skilled professionals provide outstanding care delivered with compassion, kindness, and understanding. Learn more at: www.cmmc.org.

About Bridgton Hospital

Part of Central Maine Healthcare, Bridgton Hospital serves the town of Bridgton and surrounding areas in Maine as part of an integrated regional healthcare system committed to improved access and a uniform standard of care. Bridgton Hospital was named as one of 17 top rural hospitals in the nation for the third consecutive year in 2018.

About Rumford Hospital

Part of Central Maine Healthcare, Rumford Hospital serves the town of Rumford and surrounding areas in Maine as part of an integrated regional healthcare system committed to improved access and a uniform standard of care. In 2018, Rumford Hospital was named one of 17 top rural hospitals in the nation by the Leapfrog Group; in 2016, it was designated a Pathway to Excellence® organization by the American Nurses Credentialing Center. Learn more at: www.rumfordhospital.org.

Central Maine Healthcare is equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law.

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