Senior Risk Adjustment Coding Quality Assurance Specialist (Remote)

Homeward is rearchitecting the delivery of health and care in partnership with communities everywhere, starting in rural America. Today, 60 million Americans living in rural communities are facing a crisis of access to care. In the U.S. healthcare system, rural Americans experience significantly poorer clinical outcomes. This trend is rapidly accelerating as rural hospitals close and physician shortages increase, exacerbating health disparities. In fact, Americans living in rural communities suffer a mortality rate 23 percent higher than those in urban communities, in part because of the lack of access to quality care.

Our vision is care that enables everyone to achieve their best health. So, we’re creating a new healthcare delivery model that is purpose-built for rural America and directly addresses the issues that have historically limited access and quality. Homeward supports Medicare-eligible beneficiaries by partnering with health plans, providers, and communities to align incentives – taking full financial accountability for clinical outcomes and the total cost of care across rural counties.

As a public benefit corporation and Certified B Corp™, Homeward’s mission and business model are aligned to address the healthcare, economic, and demographic challenges that make it challenging for rural Americans to stay healthy. Our Homeward Navigation™ platform uses advanced analytics to connect members to the right care and local resources that address social determinants of health and improve holistic health outcomes. Since many rural communities lack adequate clinical capacity, Homeward also employs care teams that supplement local practices and reach people who cannot otherwise access care.

Homeward is co-founded by a leadership team that defined and delivered Livongo’s products, and backed most recently by a $50 million series B co-led by Arch Ventures and Human Capital, with participation from General Catalyst for a total of $70 million in funding. With this leadership team and funding, Homeward is committed to bringing high-quality healthcare to rural communities in need.

The Opportunity

Join us in tackling healthcare for rural America! We’re seeking a Senior Risk Adjustment Coding Quality Assurance Specialist who is passionate about having a positive societal impact and using technology for good – solving issues of health inequity for communities that have been perennially underserved.

The Senior Risk Adjustment Coding Quality Assurance Specialist plays a critical role in ensuring the accuracy and compliance of Medicare Advantage risk adjustment coding processes. You will conduct quality assurance for risk adjustment coding & documentation special projects, utilizing a variety of different coding platforms. This role aims to improve the accuracy of diagnosis coding, directly affecting the quality of care and appropriate reimbursement.

What You'll Do:

• Second-Level Review & Quality Assurance (QA)
  Conduct in-depth second-level reviews of outpatient clinical documentation, focusing on identifying and supporting accurate, complete capture of risk-adjustable conditions for Medicare Advantage members. Lead quality assurance (QA) audits to assess documentation integrity, identify trends in missed opportunities, and ensure coding accuracy.
• Risk Adjustment Documentation Optimization
  Champion precise documentation that fully reflects the clinical complexity of Medicare Advantage patients. Ensure that all active, reportable diagnoses are clearly supported with Diagnosis/Status/Plan (DSP) elements within the encounter—emphasizing the clinical relevance and ongoing management of chronic and complex conditions.
• Regulatory and Guideline Adherence
  Maintain deep expertise in CMS risk adjustment guidelines, Medicare Advantage policies, and ICD-10-CM coding rules. Translate these evolving requirements into practical applications for documentation review and improvement, with an eye toward audit preparedness and compliance sustainability.
• Provider Education and Clinical Engagement
  Deliver timely, actionable feedback and education to providers, grounded in DSP-aligned documentation principles. Engage in one-on-one coaching, small-group huddles, and educational content development to drive understanding of how accurate documentation impacts patient care quality and risk-adjusted performance.
• Compliance and Risk Mitigation
  Ensure coding and documentation practices strictly adhere to Medicare Advantage regulations, including the use of AHIMA/ACDIS-compliant query formats to clarify ambiguous or incomplete documentation. Monitor for patterns that may indicate compliance concerns—such as unsupported diagnosis coding or inconsistencies—and proactively guide corrective strategies to reduce risk exposure and promote defensible documentation.
• Strategic Program Support and Expansion
  Partner in the ongoing development and scaling of Homeward’s outpatient CDI and Coding Support functions. This includes supporting pre-visit documentation reviews, integrating supplemental data (e.g., health risk assessments), and participating in new initiatives such as HEDIS abstraction, Medicaid CDI pilots, and Commercial risk adjustment reviews.

What You Bring:

Strict adherence to CMS and OIG risk adjustment guidelines, maintaining the highest standards of regulatory compliance and integrity

• 5 years of experience in risk adjustment coding and/or 3 years of outpatient CDI with a strong focus on Medicare Advantage risk adjustment
• Certified Risk Adjustment Coder (CRC) certification
• In-depth knowledge of Medicare Advantage risk adjustment methodology and coding guidelines
• Strong understanding of ICD-10-CM diagnosis coding
• Excellent communication skills
• Familiarity with risk adjustment retrospective chart review coding processes and technology
• Familiarity with electronic health record (EHR) systems
• Knowledge of healthcare compliance, regulations, and billing practices
• Analytical and problem-solving skills

Bonus Points:

• Additional AAPC or AHIMA certification (RHIA, RHIT, CDIP, etc.)
• Experience with risk adjustment technology solutions and risk adjustment retrospective chart review vendors.
• Previous experience building from the ground up on a small, fast-paced team.
• Experience with Medicare Advantage RADV audits.

Benefits

• Medical, dental, and vision insurance with 100% of monthly premium covered for employees
• Competitive salary and possible equity grant
• Supplemental performance bonus opportunities
• Relocation and travel reimbursement
• Loan repayment support
• Company-sponsored 401k plan + match
• Generous paid time off
• Comprehensive training provided

What Shapes Homeward:

• Deep commitment to one another, the people and communities we serve, and to provide care that enables everyone to achieve their best health
• Compassion and empathy
• Curiosity and an eagerness to listen
• Drive to deliver high-quality experiences, clinical care, and cost-effectiveness
• Strong focus on the sustainability of our business and scalability of our services to maximize our reach and impact
• Nurturing a diverse workforce with a wide range of backgrounds, experiences, and points of view
• Taking our mission and business seriously, but not taking ourselves too seriously– having fun as we build!

The base salary range for this position is $80,000-$90,000 annually. Compensation may vary outside of this range depending on a number of factors, including a candidate’s qualifications, skills, location, competencies and experience. Base pay is one part of the Total Package that is provided to compensate and recognize employees for their work at Homeward Health. This role is eligible for an annual bonus, stock options, as well as a comprehensive benefits package.

At Homeward, a diverse set of backgrounds and experiences enrich our teams and allow us to achieve above and beyond our goals. If you have yet to gain experience in the areas detailed above, we hope you will share your unique background with us in your application and how it can be additive to our teams.
Homeward is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, or genetic information. Homeward is committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities.

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