Registered Nurse - HCC/RAF Coding Specialist

HCC/RAF Coding Specialist in Springfield, MA | Baystate Health Careers
Department: Population Health / Risk Adjustment
Location: Baystate Health, Springfield, Massachusetts
Job Type: Full-Time
Shift: Days

Make an Impact with Baystate Health

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 MassHealth 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.

The HCC/RAF Coding Specialist Will:

• 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.

Schedule Details

• 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.

Benefits That Support You

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.

About Baystate Health

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.

Whether you provide direct patient care, clinical services, or operational support, your work at Baystate Health helps improve the health of the communities we serve.

Required Skills

• Associate's degree required.
• Current and active licensure as one of the following: RN, LPN, MD/DO, or Advanced Practice Provider (APP).
• Three (3) or more years of RN clinical experience or physician-trained clinical experience.
• Strong clinical knowledge of chronic disease processes and condition management.
• Knowledge of ICD-10 diagnosis coding principles and clinical documentation requirements.
• Understanding of CMS HCC risk adjustment methodology and reimbursement concepts.
• Proficiency with electronic medical records and Microsoft Office applications.
• Excellent written and verbal communication skills.
• Strong organizational, analytical, and problem-solving abilities with the ability to work independently.
• Driver's license required.

Preferred Qualifications & Skills

• Bachelor's degree.
• Certified Professional Coder (CPC), CRC, CCS, or similar coding certification.
• Experience with risk adjustment, HCC coding, population health, or value-based care initiatives.
• Experience providing physician education related to documentation improvement and coding compliance.
• Knowledge of Medicare Advantage, HEDIS, and quality performance programs.

Start Your Career at Baystate Health

You Belong at Baystate.

Education:

Certifications:

Compensation

Note: The compensation range(s) in the table below represent the base salaries for all positions at a given grade across the health system. Typically, a new hire can expect a starting salary somewhere in the lower part of the range. Actual salaries may vary by position and will be determined based on the candidate's relevant experience. No employee will be paid below the minimum of the range. Pay ranges are listed as hourly for non-exempt employees and based on assumed full time commitment for exempt employees.

Minimum - Midpoint - Maximum

Equal Employment Opportunity Employer

Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.