Clinical HCC​/RAF Specialist – Population Health

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Baystate Health is seeking an HCC/RAF Coding Specialist to join our Population Health team. In this role, you will help drive documentation accuracy, quality outcomes, and reimbursement integrity through comprehensive medical record review, ICD-10 diagnosis coding, and risk adjustment activities.

The HCC/RAF Coding Specialist serves as a key resource supporting providers and clinical teams by ensuring patient conditions are accurately reflected in the medical record in accordance with CMS Hierarchical Condition Category (HCC) and Mass Health DxCG guidelines. Through collaboration, education, and clinical expertise, you will improve documentation quality, support population health initiatives, enhance provider satisfaction, and contribute to the financial sustainability of value-based care programs.

• Review medical record documentation and abstract ICD-10 diagnosis codes to accurately capture patient complexity, severity of illness, and risk adjustment opportunities.
• Identify, validate, and report missing, incomplete, inaccurate, or unsupported diagnoses in accordance with CMS HCC and coding guidelines.
• Maintain and optimize patient problem lists by adding, updating, or removing diagnosis codes based on current clinical documentation.
• Collaborate with physicians and advanced practice providers to clarify ambiguous or incomplete documentation and ensure coding accuracy.
• Serve as a subject matter expert in HCC, RAF, and risk adjustment coding methodologies.
• Educate providers and staff on documentation improvement opportunities, coding requirements, and risk adjustment best practices.
• Analyze risk adjustment and population health reports to identify trends, educational needs, and reimbursement opportunities.
• Support Medicare Annual Wellness Visit initiatives and other programs that improve patient outcomes, quality measures, and coding accuracy.
• Assist with data collection, reporting, audits, and quality improvement initiatives related to documentation and coding practices.
• Identify and communicate documentation deficiencies, coding concerns, and compliance-related issues.
• Support onboarding activities for new patients to ensure accurate and complete documentation of chronic conditions and health maintenance needs.
• Adhere to all Baystate Health compliance standards, regulatory requirements, and coding guidelines.
• Job Type: Full-Time
• Shift: Days
• Hours: 40 Hours
• Schedule: Monday-Friday
• Other Scheduling Requirements: Hybrid work schedule (3 days on-site, 2 days remote) with the ability to travel to practices throughout the Baystate Health System to conduct provider education, training sessions, and on-site documentation improvement initiatives.

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: Medical, dental, and vision coverage, including local Health New England plans.
• Tuition & Training: Tuition assistance, CEUs, and professional development opportunities.
• Career Growth: Internal advancement opportunities and professional development programs.
• Regional Opportunities: Career options across Baystate Health hospitals, practices, and services throughout western Massachusetts.
• Retirement: Retirement savings and employer match.
• Paid Time Off: Generous PTO for eligible employees.

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
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Whether you provide direct patient care, clinical services, or operational support, your work at Baystate Health…