Senior Risk Adjustment Coder, Provider Enablement (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

We are seeking a Senior Risk Adjustment Coder to join our growing team and support Homeward’s External Risk Adjustment Provider Enablement efforts. This individual will play a critical role in reviewing, auditing, and analyzing outpatient clinical documentation from external provider partners, ensuring accurate and complete coding of risk-adjustable conditions.

You will work alongside our educators and managers to translate chart insights into feedback that improves documentation quality, supports proper reimbursement, and enables provider performance in risk-bearing arrangements (e.g., BCBSM PEC Incentives).

This is an ideal role for a proactive, detail-oriented coder with deep knowledge of Medicare Advantage risk adjustment, exceptional judgment, and experience supporting external practices or provider networks.

What You'll Do

• Chart Review & Coding Accuracy
• Conduct retrospective risk adjustment chart reviews for shared Homeward-patient encounters using CMS-HCC and ICD-10-CM guidelines.
• Ensure that all diagnosis codes submitted are fully supported by the medical record and documentation is complete, accurate, and compliant.
• Apply DSP (Diagnosis/Status/Plan) methodology to assess whether a condition is valid for coding and meets documentation criteria.
  
  
• Documentation Auditing & Feedback
• Identify trends in missed coding opportunities, unsupported diagnoses, and potential compliance concerns.
• Summarize audit findings to inform educator-led provider feedback sessions.
• Support performance tracking and education targeting by coding risk gaps across providers and markets.
  
  
• Compliance & Quality Assurance
• Maintain deep expertise in CMS risk adjustment policies and coding guidelines.
• Escalate concerns related to unsupported, invalid, or ambiguous documentation.
  
  
• Payer & Claims Reconciliation Support
• Cross-check codes submitted by external practices against EMR and documentation evidence.
• Flag claims where documentation supports more accurate risk-adjustable conditions than were billed.
• Support supplemental file preparation and reconciliation efforts with payer partners.
  
  
• Collaboration & Enablement Support
• Collaborate with Provider Educators to align chart findings with live education needs.
• Participate in cross-functional team meetings, retrospectives, and workflow refinements.
• Help shape internal workflows and dashboards that scale coding effectiveness across the Enablement program.
  
  

What You Bring

• Ability to travel up to 20% of the time
• 5+ years of experience in risk adjustment coding, preferably with a focus on Medicare Advantage.
• Certified Risk Adjustment Coder (CRC) from AAPC required; additional certifications (e.g., CCS, CPC, CDIP) strongly preferred.
• Deep expertise in ICD-10-CM, CMS-HCC v24/v28, and OIG/CMS regulatory compliance.
• Strong familiarity with outpatient and primary care clinical documentation, including EMR navigation and E/M coding patterns.
• Demonstrated success in coding QA/auditing, especially in a value-based care environment or provider enablement setting.
• Comfort working independently, prioritizing workload, and managing tight review timelines.
  
  

Bonus Points

• Experience with Payer Incentive Programs.
• Background working with external provider groups or vendor-contracted practices.
• Familiarity with risk adjustment data platforms and chart review tools.
• Experience building coding workflows from scratch or iterating in an early-stage environment.

What Shapes Our Company

• Deep commitment to one another, the people and communities we serve, and to 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 sustainability and scalability of our services
• Nurturing a diverse workforce with a wide range of backgrounds and points of view
• Taking our mission seriously - but not ourselves too seriously; we have fun as we build

Benefits

• Competitive salary and equity grant
• Unlimited Paid Time Off
• 100% of employee premiums covered for medical, dental & vision insurance
• Company-sponsored 401k plan
• Ongoing professional development opportunities

The base salary range for this position is $55,000K - 87,000K 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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